Form I-130 02/27/17 N Page 9 of 12
Part 5. Other Information (continued)
Petitioner's Daytime Telephone Number3.
Petitioner's Contact Information
Petitioner's Email Address (if any)5.
Petitioner's Mobile Telephone Number (if any)4.
WARNING: USCIS investigates the claimed relationships and
verifies the validity of documents you submit. If you falsify a
family relationship to obtain a visa, USCIS may seek to have
you criminally prosecuted.
PENALTIES: By law, you may be imprisoned for up to 5
years or fined $250,000, or both, for entering into a marriage
contract in order to evade any U.S. immigration law. In
addition, you may be fined up to $10,000 and imprisoned for
up to 5 years, or both, for knowingly and willfully falsifying
or concealing a material fact or using any false document in
submitting this petition.
I can read and understand English, and I have read
and understand every question and instruction on this
petition and my answer to every question.
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
Part 6. Petitioner's Statement, Contact
Information, Declaration, and Signature
NOTE: Read the Penalties section of the Form I-130
Instructions before completing this part.
The interpreter named in Part 7. read to me every
question and instruction on this petition and my
answer to every question in
a language in which I am fluent. I understood all of
this information as interpreted.
2. At my request, the preparer named in Part 8.,
prepared this petition for me based only upon
information I provided or authorized.
Petitioner's Declaration and Certification
Copies of any documents I have submitted are exact
photocopies of unaltered, original documents, and I understand
that USCIS may require that I submit original documents to
USCIS at a later date. Furthermore, I authorize the release of
any information from any of my records that USCIS may need
to determine my eligibility for the immigration benefit I seek.
I further authorize release of information contained in this
petition, in supporting documents, and in my USCIS records to
other entities and persons where necessary for the administration
and enforcement of U.S. immigration laws.
I understand that USCIS may require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, if I am required to provide
biometrics, I will be required to sign an oath reaffirming that:
1) I provided or authorized all of the information
contained in, and submitted with, my petition;
2) I reviewed and understood all of the information in,
and submitted with, my petition; and
3) All of this information was complete, true, and correct
at the time of filing.
I certify, under penalty of perjury, that all of the information in
my petition and any document submitted with it were provided
or authorized by me, that I reviewed and understand all of the
information contained in, and submitted with, my petition, and
that all of this information is complete, true, and correct.
NOTE TO ALL PETITIONERS: If you do not completely
fill out this petition or fail to submit required documents listed
in the Instructions, USCIS may deny your petition.
Date of Signature (mm/dd/yyyy)
Petitioner's Signature (sign in ink)6.a.