❶ 浜插睘绉绘皯I-130琛ㄦ牸镐庝箞濉鍐
I-130琛ㄦ牸濉鍐椤叾瀹炲苟涓嶅嶆潅锛屾诲叡灏变袱椤点傜涓椤垫渶涓婃柟链変竴涓澶ф嗭纴鍐欑潃钬淒O NOT WRITE IN THIS BLOCK-FOR USCIS OFFICE ONLY钬濄备綔涓虹敌璇蜂汉链浜猴纴涓岖敤绠¤繖涓妗嗛噷镄勫唴瀹癸纴闾ｆ槸绉绘皯瀹桦～鍐欑殑鍦版柟銆傛帴涓嬫潵锛屾墠鏄鐢宠蜂汉闇瑕佸～鍐欑殑淇℃伅銆
A. Relationship.
杩欎竴閮ㄥ垎鏄濉鍐欎綘鍜屼綘鍗冲皢涓哄叾鐢宠风豢鍗＄殑闾ｄ釜浜蹭汉(涓嬫枃绠绉扳滀翰浜衡)镄勫叧绯汇备妇涓渚嬶纴濡傛灉浣犳槸缇庡浗鍏姘戯纴浣犳兂涓轰綘鍦ㄤ腑锲界殑濡诲瓙鐢宠风豢鍗★纴闾ｄ箞浣犲氨鏄痯etitioner锛屼綘镄勫诲瓙灏辨槸杩欎釜钬滀翰浜衡濓纴涔熷氨鏄痓eneficiary.
1. I am filing this petition for my:
Husband/Wife (濡傛灉鏄涓鸿嚜宸辩殑閰嶅伓鐢宠风豢鍗★纴鍒椤嬀阃夎繖涓椤)
Parent (濡傛灉鏄涓鸿嚜宸辩殑鐖舵瘝鐢宠风豢鍗★纴鍒椤嬀阃夎繖涓椤)
Brother/Sister (濡傛灉鏄涓鸿嚜宸辩殑鍏勫纻濮愬圭敌璇风豢鍗★纴鍒椤嬀阃夎繖涓椤)
Child (濡傛灉鏄涓鸿嚜宸辩殑瀛愬コ鐢宠风豢鍗★纴鍒椤嬀阃夎繖涓椤)
2. Are you related by adoption?
Yes (濡傛灉浣犲拰浣犵殑浜蹭汉涓嶆槸浜茬敓琛缂桦叧绯伙纴钥屾槸阃氲繃鏀跺吇鍏崇郴寤虹珛镄勶纴鍒欓夎繖涓椤)
No (濡傛灉浣犲拰浣犵殑浜蹭汉鏄浜茬敓琛缂桦叧绯伙纴鍒欓夎繖涓椤广傚ぇ閮ㄥ垎鐢宠蜂汉阃傜敤浜庤繖涓椤)
3. Did you gain permanent residence through adoption?
Yes (濡傛灉浣犳湰浜哄綋鍒濇槸阃氲繃鏀跺吇鍏崇郴銮峰缑缁垮崱镄勶纴闾ｄ箞阃夎繖涓椤)
No (濡傛灉浣犳湰浜哄綋鍒濅笉鏄阃氲繃鏀跺吇鍏崇郴銮峰缑缁垮崱镄勶纴闾ｄ箞阃夎繖涓椤广傚ぇ閮ㄥ垎鐢宠蜂汉阃傜敤浜庤繖涓椤)
B. Information about you
杩欎竴閮ㄥ垎鏄濉鍐椤叧浜庝綘链浜(缇庡浗鍏姘戞垨钥呯豢鍗)镄勪俊鎭銆
1-5椤瑰垎鍒鏄濉鍐欎綘镄勫悕瀛椾付阃氢俊鍦板潃涓跺嚭鐢熷湴涓跺嚭鐢熸棩链熶付镐у埆锛屽傚疄濉鍐椤氨鏄浜嗐
绗6椤规槸闂浣犵殑濠氩Щ鐘跺喌銆傚叾涓锛孧arried鏄宸插氾纴Single鏄链濠氾纴Widowed鏄涓у伓锛娈ivorced鏄绂诲氥
绗7椤规槸闂浣犳槸钖︾敤杩囨浘鐢ㄥ悕銆傚傛灉娌℃湁锛屽氨绌虹潃涓嶅～銆
绗8椤光淒ate and Place of Present Marriage钬濇槸闂浣犲綋鍓嶅氩Щ(濡傛灉浣犲綋鍓嶆槸钬滃凡濠气濈姸镐佺殑璇)镄勭粨濠氭椂闂村拰鍦扮偣銆傚傛灉浣犳槸链濠氭垨钥呯诲氱姸镐侊纴杩欓”涓岖敤濉銆
绗9椤瑰～浣犵殑绀句细瀹夊叏鍙稴ocial Security Number.
绗10椤瑰～浣犵殑Alien Registration Number(绠绉痨 Number)銆备綘褰揿埯鐢宠风豢鍗℃椂锛岄掍氦I-485钖庯纴绉绘皯灞灏变细缁欎綘涓涓狝 Number. 杩欎釜鍙风爜灏辨槸浣犵殑缁垮崱姝ｉ溃涓婇偅涓浠A#镓揿ご镄勫彿镰侊纴姣斿傦细A# 123-456-789(鏁板瓧鍏9浣)銆
绗11椤瑰拰12椤规槸濉鍐欎綘镄勫墠澶(鍓嶅)镄勫悕瀛楋纴鍜岀诲氱殑镞堕棿銆傚傛灉浠ュ墠娌℃湁绂昏繃濠氾纴杩欓”灏辩┖镌涓嶅～銆
绗13椤规槸濉鍐欎綘銮峰缑缇庡浗鍏姘戣韩浠界殑阃斿缎銆侭irth in the U.S. (濡傛灉浣犳槸锲犱负鍑虹敓鍦ㄧ编锲借岃幏寰楃编锲藉叕姘戞潈镄勶纴鍒欓夎繖涓椤)
Naturalization. Give the certificate number and date and place of issuance (濡傛灉浣犳槸阃氲繃绉绘皯鐢宠疯幏寰楃编锲藉叕姘戞潈镄勶纴鍒椤～鍐栾繖涓椤广傚悓镞堕渶瑕佸～鍐欎綘鍏姘戣瘉镄勭紪鍙蜂付镞ユ湡鍜屽湴镣)
Parents. Have you obtained a certificate of citizenship in your own name? (杩欎竴椤规槸闂浣犳槸涓嶆槸浠ヤ綘镊宸卞悕涔夌敌璇峰埌缇庡浗鍏姘戠殑?濡傛灉鏄锛屽氨阃塝es,骞跺悓镞跺～鍐欎綘镄勫叕姘戣瘉镄勭紪鍙蜂付镞ユ湡鍜屽湴镣;濡傛灉涓嶆槸锛屽氨濉玁o銆备负浠涔堜细链夎繖涓阃夐”锻?瀵逛簬18宀佷互涓嬬殑瀛╁瓙锛屽傛灉鍦ㄦ嬁缁垮崱5骞村悗锛屼粛铹惰缮涓嶆弧18宀侊纴灏变笉鑳戒互镊宸卞悕涔夌敌璇峰姞鍏ョ编锲藉浗绫嶏纴鍙鑳介氲繃鐖舵瘝鐢宠峰姞鍏ョ编锲藉浗绫嶃傝繖绉嶆儏鍐典笅锛岃繖涓瀛╁瓙灏变笉鏄浠ヨ嚜宸卞悕涔夋嬁鍒扮编锲藉叕姘戣瘉镄勶纴钥屾槸浠ョ埗姣嶅悕涔夋嬁鍒扮殑)
绗14椤癸纴濡傛灉浣犳槸缇庡浗缁垮崱鎸佹湁浜猴纴鍒椤～鍐栾繖涓椤广傚傛灉浣犳槸鍦ㄧ编锲藉冨栫敌璇风Щ姘戠捐瘉𨱒ョ编锲斤纴銮峰缑缇庡浗缁垮崱镄勶纴鍒椤～鍐椤叆澧幂编锲界殑镞ユ湡鍜屾捣鍏冲湴镣(Date and place of admission).娉ㄦ剰锛歛dmission杩欎釜鍗曡瘝鏄涓挞棬鐢ㄤ簬阃氲繃鐢宠风Щ姘戠捐瘉鍏ュ幂编锲芥嬁缁垮崱镄勬柟寮忋傚湪缇庡浗澧冨唴阃扞-485杩欎釜鏂瑰纺锛岀О涓篴djustment of status锛屼笉鍙玜dmission.濡傛灉浣犳槸鍦ㄧ编锲藉冨唴阃氲繃阃掍氦I-485𨰾垮埌缁垮崱镄勶纴鍒椤～鍐欎綘I-485镓瑰嗳镄勯偅涓澶╃殑镞ユ湡鍜屾壒鍑嗕綘镄処-485镄勯偅涓猆SCIS SERVICE CENTER钖嶅瓧(渚嫔傦纴濡傛灉鏄疶SC锛屽氨濉玊EXASSERVICE CENTER;濡傛灉鏄疦SC锛屽氨濉玁EBRASKA SERVICE CENTER)銆
Class of admission鏄濉鍐欎綘銮峰缑缁垮崱镄勭被鍒銆傚傛灉鏄鍦ㄧ编锲藉冨栭氲繃绉绘皯绛捐瘉绉绘皯缇庡浗镄勶纴鍒椤～鍐欎綘镄勭Щ姘戠捐瘉镄勭被鍒(渚嫔傦纴濡傛灉浣犲綋鍒濇槸浣滀负缇庡浗鍏姘戠殑閰嶅伓𨱒ョ编锲界殑锛屽氨濉献R-1锛岃繖閲岀殑IR-1灏辨槸浣犲綋鍒濆湪缇庡浗椹诲箍宸为嗕簨棣嗙敌璇峰埌镄勭Щ姘戠捐瘉绫诲埆);濡傛灉浣犳槸鍦ㄧ编锲藉冨唴阃氲繃阃掍氦I-485銮峰缑缁垮崱镄勶纴闾ｄ箞浣犲氨濉鍐欎綘镄処-140鎴栬匢-130鐢宠风殑浼桦厛绫诲埆(姣斿傚傛灉浣犳槸EB1锛屼綘灏卞～鍐椭mployment-Based 1st Preference)銆
绗14b椤癸纴鏄闂浣犳槸涓嶆槸阃氲繃璺熺编锲藉叕姘戞垨钥呯豢鍗＄粨濠氭嬁鍒扮豢鍗＄殑?濡傛灉鏄锛屼綘灏卞～Yes;濡傛灉涓嶆槸锛屼綘灏卞～No銆
C. Information about your relative銆
杩欎竴閮ㄥ垎鏄濉鍐椤叧浜庝綘鍗冲皢涓哄叾鐢宠风豢鍗＄殑闾ｄ釜浜蹭汉(涓嬫枃绠绉扳滀翰浜衡)镄勪俊鎭銆
1-12椤瑰熀链鍜屸淎. Information about you钬濆畬鍏ㄤ竴镙凤纴闇瑕佹敞镒忕殑鏄锛屽傛灉链変簺椤规病链夛纴灏辩┖镌锛屼笉瑕佸～none,涔熶笉瑕佸～N/A涔嬬被镄勶纴瀹规槗寮曡捣绉绘皯瀹樿浼氥备緥濡傜9椤癸纴绀句细瀹夊叏鍙凤纴濡傛灉娌℃湁锛屽氨绌虹潃锛屼笉瑕佸～銆
绗13椤癸纴鏄闂浣犵殑浜蹭汉鏄钖︽潵杩囩编锲?濡傛灉鏄锛屽嬀阃墆es;濡傛灉涓嶆槸锛屽嬀阃塶o.
绗14椤癸纴鏄闂浣狅纴濡傛灉浣犵殑浜蹭汉鐜板湪灏卞湪缇庡浗锛岄偅涔堜粬(濂)𨱒ョ编锲界殑鏂瑰纺鏄浠涔堛
濡傛灉鏄疛1锛屽氨鍦ㄢ淗e or she arrived as a:钬濆悗闱㈠～Exchange visitor(J1).
濡傛灉鏄疕1-B锛屽氨鍦ㄢ淗e or she arrived as a:钬濆悗闱㈠～Temporary worker(H1-B).
濡傛灉鏄疐1,灏卞湪钬淗e or she arrived as a:钬濆悗闱㈠～Student(F1).
濡傛灉鏄叠1锛屽氨鍦ㄢ淗e or she arrived as a:钬濆悗闱㈠～Visitor (B1).绛夌瓑銆
铹跺悗濉鍐椤綋鍒濆叆澧幂编锲芥椂镄処-94鍙凤纴鍜屽叆澧幂编锲界殑镞ユ湡(Date Arrived).铹跺悗濉鍐橧-94鍗＄殑杩囨湡镞ユ湡(鍗矷-94鍗′笂valid stay镄勬渶钖庝竴澶)銆
绗15椤. 濉鍐欎綘镄勪翰浜哄綋鍓嶉泧涓荤殑钖嶅瓧涓跺湴鍧鍜岄泧浣ｅ紑濮嬫棩链熴傚傛灉鏄瀛︾敓锛屽氨绌虹潃涓嶅～銆
绗16椤. 鏄闂浣犵殑浜蹭汉鏄钖﹁繘鍏ヨ繃缇庡浗绉绘皯灞阃掕В鍙告硶绋嫔簭?澶ч儴鍒嗙敌璇蜂汉閮借繖涓椤归兘鏄濉玁o.
绗17椤(I-130琛ㄧ浜岄〉椤堕儴寮濮嬶纴浠庣17椤瑰埌绗22椤癸纴浠嶅睘浜"C. Information about your alien relative").
杩欎竴椤癸纴闇瑕佸垪鍑轰綘浜蹭汉镄勯厤锅朵付瀛╁瓙镄勫揿悕涓惰窡浣犱翰浜虹殑鍏蜂綋鍏崇郴锛屽嚭鐢熸棩链燂纴鍑虹敓锲藉躲傚傚疄濉鍐椤氨琛屻
绗18椤癸纴闇瑕佸～鍐欎綘浜蹭汉绉绘皯缇庡浗钖庯纴𨰾熷皢瑕佸眳浣忕殑鍦版柟銆傚傛灉浣犵殑杩欎釜钬滀翰浜衡濇槸浣犵殑閰嶅伓鎴栬呭╁瓙锛屼竴鑸灏卞～浣犺嚜宸卞眳浣忓湴鍧锛屾瘆杈冨彲淇°
绗19椤广傜敤鑻辨枃濉鍐欎綘浜蹭汉褰揿墠鍦ㄤ腑锲(濡傛灉浣犱翰浜轰笉鏄鍦ㄤ腑锲斤纴鍒椤～浠栫殑瀹为檯灞呬綇鍦板潃)镄勫眳浣忓湴鍧(闇瑕佹彁渚涜楅亾鍙凤纴琛楅亾锛屽煄甯傦纴鐪佷细鍜屽浗瀹)銆
绗20椤广傜敤涓鏂囧～鍐欎綘浜蹭汉褰揿墠鍦ㄤ腑锲(濡傛灉浣犱翰浜轰笉鏄鍦ㄤ腑锲斤纴鍒椤～浠栫殑瀹为檯灞呬綇鍦板潃)镄勫眳浣忓湴鍧(闇瑕佹彁渚涜楅亾鍙凤纴琛楅亾锛屽煄甯傦纴鐪佷细鍜屽浗瀹)銆
绗21椤广傚傛灉浣犳槸涓轰綘镄勯厤锅剁敌璇风豢鍗★纴闾ｄ箞闇瑕佸～鍐栾繖涓椤广傚～鍐欐渶杩戜竴娆′綘浠鍏卞悓鐢熸椿鍦ㄤ竴璧风殑鍦板潃鍜岃捣姝㈡椂闂淬
绗22椤广傚傛灉浣犵殑浜蹭汉鐜板湪灏卞湪缇庡浗锛屽垯绉绘皯灞璁や负浠(濂)浼氩湪缇庡浗澧冨唴璋冩暣韬浠斤纴銮峰缑缁垮崱銆傝繖绉嶆儏鍐碉纴闇瑕佸～鍐欎綘镄勪翰浜洪掍氦I-485镄勯偅涓猆SICS OFFICE鍦扮偣(I-130琛ㄦ牸绗浜岄〉绗22椤逛笅闱㈠乏鍗婇儴鍒嗙殑City鍜孲tate)銆傚逛簬澶ч儴鍒嗗跺涵绫荤Щ姘戠敌璇凤纴鏄疷SCIS Chicago Lockbox鍙楃悊锛屽洜姝City灏卞～锛欳hicago,State灏卞～锛欼llinois銆
绗22椤逛笅鏂瑰彸鍗婇儴鍒嗙殑City鍜孋ountry鏄璇达纴濡傛灉浣犵殑浜蹭汉涓嶅叿澶囧湪缇庡浗澧冨唴璋冩暣韬浠界殑璧勬牸(鍗充笉鑳介掍氦I-485)锛屾垨钥呬綘镄勪翰浜哄皢鍦ㄧ编锲介┗娴峰栫殑涓涓棰嗕簨棣嗙敌璇风Щ姘戠捐瘉铹跺悗𨱒ョ编锲斤纴闾ｄ箞闇瑕佸～鍐欑22椤逛笅鏂瑰彸鍗婇儴鍒嗙殑City鍜孋ountry銆傚逛簬涓锲藉ぇ闄嗙敌璇蜂汉钥岃█锛屽跺涵绫荤Щ姘戜竴鑸鏄鐢辩编锲介┗骞垮窞棰嗕簨棣嗗弹鐞嗭纴锲犳City濉锛欸uangzhou, Country濉锛歅.R.China銆
D. Other information
绗1椤癸纴濡傛灉浣犲悓镞惰缮涓哄叾浠栦翰浜洪掍氦浜嗗崟镫镄処-130锛屽垯鍦ㄨ繖閲屽垪鍑哄叾浠栦翰浜虹殑钖嶅瓧鍜岃窡浣犵殑鍏崇郴銆
绗2椤规槸闂浣狅纴浣犱互鍓嶆浘缁忎负褰揿墠杩欎綅浜蹭汉鎴栧叾浠栦翰浜虹敌璇疯繃I-130钖?濡傛灉鏄锛屽嬀阃墆es(钖屾椂鍦ㄤ笅鏂瑰～鍐欓偅钖崭翰浜虹殑钖嶅瓧锛孖-130阃掍氦镄勬椂闂村拰USCIS SERVICE CENTER鍦板潃);濡傛灉涓嶆槸锛屽垯鍕鹃塶o.
E. Signature of petitioner
濡傛灉杩欎唤I-130琛ㄦ槸浣犳湰浜哄～鍐欑殑锛屽垯鍦ㄨ繖涓椤归噷绛句綘链浜虹殑濮揿悕锛屾棩链熷拰鐢佃瘽鍙风爜銆
F. Signature of person preparing this form, if other than the petitioner.
濡傛灉杩欎唤I-130涓嶆槸浣犳湰浜哄～鍐欑殑锛岃屾槸浣犲旀墭鍏朵粬浜哄～鍐欑殑锛屽垯鍙楀旀墭浜洪渶瑕佸湪杩欎竴椤归噷绛句笂浠(濂)镄勫悕瀛楋纴镞ユ湡鍜屽湴鍧銆
浠ヤ笂鏄浜插睘绉绘皯I-130琛ㄦ牸濉鍐欐柟娉曞叏閮ㄥ唴瀹广