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COUGLE, ESQ. ATTORNEY AT LAWFamily Based Immigration Questionnaire Please enter your answers into the shaded column PRELIMINARY QUESTIONSI am filing this petition for my Are you related to Beneficiary by adoption:Yes____ No _____ INFORMATION ABOUT U.S. PETITIONERLast NameFirst NameFull Middle NameOther Names Used (Maiden):Sex (Male or Female):Status (LPR or Citizen):Did you gain permanent residence through adoption?Yes____ No _____If you are a U.S. Citizen, how did you acquire citizenship?Birth in the US _____________ Naturalization_____ Certificate No._________________ Date and place of issue of certificate______________________ Parents _____ ________ Have you obtained a certificate of citizenship in your own name?Certificate no.______________, date and place of issue________. If you are a lawful permanent resident alien, complete the following:Date and place of admission for, or adjustment to, lawful permanent residence and class of admission ___________________________Did you gain permanent resident status through marriage to a United States citizen or lawful permanent resident? Yes____________ No_____________U.S. Address:Home phone:Cell PhoneOffice phone:Fax Number:Email Address:Date of Birth (mo/day/year):Place of Birth (City, State/Province, Country):U.S. Social Security Number:Alien Registration Number (if any):Marital Status (Mark one):__Married _____ Single ______Widowed___Divorced  INFORMATION FOR THE U.S. PETITIONER S PARENTSInformation about FatherLast Name First NameMiddle NameDate of BirthCity & County of BirthCity and Country of ResidenceInformation about MotherMaiden NameFirst NameMiddle NameDate of birthCity and Country of birthCity and Country of Residence INFORMATION ABOUT THE U.S. PETITIONER S MARRIAGE Current MarriageName of SpouseDate of Birth of SpousePlace of Birth of SpouseDate and place of marriagePrevious MarriageName of former SpouseDate of birth of former SpousePlace of Birth of former SpouseDate and Place of Previous MarriageDate and Place of termination of marriagePrevious MarriageName of former SpouseDate of birth of former SpousePlace of Birth of former SpouseDate and Place of Previous MarriageDate and Place of termination of marriagePrevious MarriageName of former SpouseDate of birth of former SpousePlace of Birth of former SpouseDate and Place of Previous MarriageDate and Place of termination of marriage INFORMATION ABOUT THE U.S. PETITIONER S RESIDENCE FOR THE PAST FIVE YEARS Please list current address first Street AddressCityState and Zip CodeFrom (mm/dd/yy)To (mm/dd/yy)INFORMATION ABOUT THE U.S. PETITIONER S LAST RESIDENCE ABROAD Street AddressCityCountryFrom (mm/dd/yy)To (mm/dd/yy) INFORMATION ABOUT THE U.S. PETITIONER'S EMPLOYMENT FOR THE PAST FIVE YEARS Please list current employment first Name and address of employer OccupationFrom (mm/dd/yyTo (mm/dd/yy) PHYSICAL INFORMATION ABOUT PETITIONEREthnicityRaceHeightWeightEye ColorHair Color OTHER INFORMATION ABOUT PETITIONERHave you EVER previously filed a petition for this beneficiary or any other alien?Yes____________ No_____________If you answered "Yes," provide the name, place, date of filing, and the result.Name ________ City/Town __________ State__________ Date Filed _____________ Result _______________If you are also submitting separate petitions for other relatives, provide the names of and your relationship to each relative:Name ______________ Relationship to you _______________________________________________________________________ PLEASE ANSWER THESE QUESTIONS ABOUT YOUR ALIEN RELATIVE INFORMATION ABOUT YOUR ALIEN RELATIVELast NameFirst NameFull Middle NameOther Names Used (Maiden):Sex (Male or Female):Current Address:Foreign Address:Address in the U.S. Where Relative Will Reside:Home Telephone:Home Country Telephone:Office Telephone:Fax Number:Email Address:Date of Birth (mo/day/year):Place of Birth (City, State/Province, Country):U.S. Social Security Number:Alien Registration Number (if any):Marital Status (mark one):__Married _____ Single ______Widowed___DivorcedIf Married, Date and Place of Present Marriage:Names of Prior Husbands/Wives and Date(s) Marriage(s) Ended:Has your relative ever been to the U.S.? Yes/No:List Name and Address of Current Employer and Date this Employment Began (if applicable):Address of where you intend to live in U.S.:Passport Information:Passport Number __________ Country ___________ Expiration ___________Travel Document Number ________Was the beneficiary EVER in immigration proceedings?Yes____________ No_____________List Husband/Wife and children of your relativeFull NameRelationshipDate of BirthCountry of Birth If the relative is the Spouse of U.S. petitioner, please complete the following: INFORMATION FOR THE FOREIGN SPOUSE S PARENTSInformation about FatherLast Name First NameMiddle NameDate of BirthCity & County of BirthCity and Country of ResidenceInformation about MotherMaiden NameFirst NameMiddle NameDate of birthCity and Country of birthCity and Country of Residence INFORMATION ABOUT THE FOREIGN SPOUSE S MARRIAGE Current MarriageName of SpouseDate of Birth of SpousePlace of Birth of SpouseDate and place of marriagePrevious MarriageName of former SpouseDate of birth of former SpousePlace of Birth of former SpouseDate and Place of Previous MarriageDate and Place of termination of marriage INFORMATION ABOUT THE FOREIGN SPOUSE S RESIDENCE FOR THE PAST FIVE YEARS Please list current address first Street AddressCityState From (mm/dd/yy)To (mm/dd/yy)INFORMATION ABOUT THE FOREIGN SPOUSE S EMPLOYMENT FOR THE PAST FIVE YEARS Please list current employment first Name and address of employer OccupationFrom (mm/dd/yy)To(mm/dd/yy) BENEFICIARY S U.S. ENTRY INFORMATION Was the beneficiary EVER in the United States?Yes____ No _____ IF NO, IGNORE THE REST OF THIS SECTIONHe or she arrived as a (Class of Admission):Form I-94 Arrival-Departure Record Number:Date of Arrival (mm/dd/yyyy):Date authorized stay expired, or will expire, as shown on Form I-94 or Form I-95 (mm/dd/yyyy) or type or print "D/S" for Duration of Status:Passport Number:Travel Document Number:Country of Issuance for Passport or Travel Document:Expiration Date for Passport or Travel Document (mm/dd/yyyy): ADDITIONAL INFORMATION FOR BENEFICIARYWas the beneficiary EVER in immigration proceedings?Yes____ No _____ If you answered "Yes," select the type of proceedings and provide the location and date of the proceedings.Removal_____ Rescission ______Exclusion/Deportation______Other Judicial Proceedings City/Town_____ State______Date (mm/dd/yyyy)______If the beneficiary's native written language does not use Roman letters, type or print his or her name and foreign address in their native written language:If filing for your spouse, provide the last address at which you physically lived together. If you never lived together, type or print, "Never lived together" Date From (mm/dd/yyyy) Date To (mm/dd/yyyy)___The beneficiary is in the United States and will apply for adjustment of status to that of a lawful permanent resident at the U.S. Citizenship and Immigration Services (USCIS) office in:City/Town_____ State______The beneficiary will not apply for adjustment of status in the United States, but he or she will apply for an immigrant visa abroad at the U.S. Embassy or U.S. Consulate in:City/Town_____ Province______Country___REQUIRED DOCUMENTS TO PREPARE UPON APPLICATION'S FINAL SUBMISSION FILING FEES (MAKE CHECK PAYABLE TO DEPARTMENT OF HOMELAND SECURITY) Filing fee (See  HYPERLINK "http://www.uscis.gov/i-130"http://www.uscis.gov/i-130 for current fees) FORMS (LAW FIRM WILL PREPARE) Form G-28 - Notice of Appearance for the attorney or representative Form I-130 Petition to Classify Status of Alien Relative for Issuance of Immigrant Visa SUPPORTING DOCUMENTATION (REQUIRED FROM PETITIONER/BENEFICIARY) Naturalization certificate (or birth certificate) - if Petitioner is US Citizen Copy of "Green Card" - if Petitioner is Permanent Resident Birth certificate of Petitioner (OR Certificate of Non-availability and two affidavits) Copy of Petitioner's passport biographic page Copy of Beneficiary's passport biographic page Birth certificate of Beneficiary (OR Certificate of Non-availability and two affidavits) Must provide copy of birth certificates with translation if not in English, with translation certificate; if birth certificate is unavailable  must have statement from home government that birth certificate is unavailable (Certificate Of Non-Availability Of Birth Certificate) in combination with 2 affidavits of birth) Marriage certificate if spousal petition Divorce decrees or death certificates as evidence of dissolution of prior marriages for spousal petitions Any other evidence to establish relationship between Petitioner and Beneficiary Two color Passport Photos on a White Background of both spouses when the petition is based on a spousal relationship ***THE USE OR SUBMISSION OF THIS QUESTIONNAIRE DOES NOT CONSTITUTE REPRESENTATION COUGLE LAW, L.L.C., NOR SHALL IT BE CONSIDERED LEGAL ADVICE*** M: P.O. 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/ / / .8HhvbN:@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`a$$IfTT&    @ p p 44l44lf44/ / / / @$Ifd$a$G$^]`h@$Ifd$a$G$^]`$$IfTTr* ^&                2p2p244l44lf44/ / / / / / / @$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`6$$IfTTr* ^&                2p2p244l44lf44/ / / / / / / , z | xdP<@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`a$$IfTT&    @ p p 44l44lf44/ / / / @$Ifd$a$^]`@$Ifd$a$G$^]` ! !$$$IfTT\^&             (p(p(44l44lf44/ / / / / / / @$Ifd$a$G$^]` ! !!!!@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`!!!8$@$Ifd$a$G$^]`$$IfTT\^&             (p(p(44l44lf44/ / / / / / / !!!!@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`!! !8$@$Ifd$a$G$^]`$$IfTT\^&             (p(p(44l44lf44/ / / / / / /  !"!$!&!@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`&!(!*!8$@$Ifd$a$G$^]`$$IfTT\^&             (p(p(44l44lf44/ / / / / / / *!,!.!0!@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`0!2!4!8$@$Ifd$a$G$^]`$$IfTT\^&             (p(p(44l44lf44/ / / / / / / 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d'f'|'~'''nYDn/$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &       pp44l44lf44/ / / / / / / ''''''YD/Y$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &       pp44l44lf44/ / / / / / / $If$a$ `0$G$' (((2(D/$If$a$ `0$G$$$IfTT0^ &       pp44l44lf44/ / / / / / / $If$a$ `0$G$$If$a$ `0$G$2(4(6(X(Z(WB-$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &        pp44l44lf44/ / / / / / / $If$a$ `0$G$Z(\(((((nYDn/$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &       pp44l44lf44/ / / / / / / ((())YD/$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &       pp44l44lf44/ / / / / / / $If$a$ `0$G$))<)>)|gR$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &     pp44l44lf44/ / / / / >)@)X)Z)\)nYDn$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &       pp44l44lf44/ / / / / / / \)z)|)~))4$$IfTT0^ &       pp44l44lf44/ / / / / / / $If$a$ `0$G$%$If$a$ 2`0p@ P !$G$)))*Y4%$If$a$ 2`0p@ P !$G$$$IfTT0^ &       pp44l44lf44/ / / / / / / $If$a$ `0$G$** *Z*Y4%$If$a$ 2`0p@ P !$G$$$IfTT0^ &       pp44l44lf44/ / / / / / / $If$a$ `0$G$Z*\*^***YD/$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &       pp44l44lf44/ / / / / / / $If$a$ `0$G$***@+lWB$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &        pp44l44lf44/ / / / / / / @+B++++ ,nYDn/$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &       pp44l44lf44/ / / / / / /  ,",$,,,,YD/Y$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &       pp44l44lf44/ / / / / / / $If$a$ `0$G$,>-@-B--D/$If$a$ `0$G$$$IfTT0^ &       pp44l44lf44/ / / / / / / $If$a$ `0$G$$If$a$ `0$G$----*.gR=$If$a$ `0$G$$If$a$ `0$G$$$IfTT0^ &     pp44l44lf44/ / / / / $If$a$ `0$G$*.../B/D/gR/g"$Ifd$a$ `0$7$5$9DG$^]`$If$a$ `0$G$$$IfTT0^ &     pp44l44lf44/ / / / / $If$a$ `0$G$D//////t_J$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$a$$IfTT&    @ p p 44l44lf44/ / / / $If$a$ `0$G$/0$If$a$ `0$G$00$$IfTT\B =&             (p(p(44l44lf44/ / / / / / / / / / / / / 00000$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$00$$IfTT\B =&             (p(p(44l44lf44/ / / / / / / / / / / / / 0 0"0$0&0$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$&0(0$$IfTT\B =&             (p(p(44l44lf44/ / / / / / / / / / / / / (0*0,0.000$If$a$ `0$G$$If$a$ `0$G$$If$a$ 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    pp44l44lf44/ / / / / / / t3333v@$Ifd$a$G$^]`a$$IfTT&    @ p p 44l44lf44/ / / / @$Ifd$a$G$^]`3344|@$IfdG$^]`@$IfdG$^]`a$$IfTT&     p p 44l44lf44/ / / / 4 4P4R4T44n]Ln;@$IfdG$^]`@$IfdG$^]`@$IfdG$^]`$$IfTT0&       pp44l44lf44/ / / / / / / 444444]L;]@$IfdG$^]`@$IfdG$^]`$$IfTT0&       pp44l44lf44/ / / / / / / @$IfdG$^]`44455yh@$IfdG$^]`@$IfdG$^]`a$$IfTT&     p p 44l44lf44/ / / / @$Ifd$a$G$^]`55X5Z5\55n]Ln;@$IfdG$^]`@$IfdG$^]`@$IfdG$^]`$$IfTT0&       pp44l44lf44/ / / / / / / 555555]L;]@$IfdG$^]`@$IfdG$^]`$$IfTT0&       pp44l44lf44/ / / / / / / @$IfdG$^]`5@6B6D6F66LJ6@$Ifd$a$G$^]`$$IfTT0&       pp44l44lf44/ / / / / / / @$IfdG$^]`@$IfdG$^]`6"7$7B7L7Z7z7xdP<@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`a$$IfTT&    @ p p 44l44lf44/ / / / @$Ifd$a$^]`z77@$Ifd$a$G$^]`77$$IfTTr^ K&                2p2p244l44lf44/ / / / / / / 777777@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`77$$IfTTr^ K&                2p2p244l44lf44/ / / / / / / 777777@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`77$$IfTTr^ K&                2p2p244l44lf44/ / / / / / / 777777@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`77$$IfTTr^ K&                2p2p244l44lf44/ / / / / / / 777777@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`77$$IfTTr^ K&                2p2p244l44lf44/ / / / / / / 777777@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`77$$IfTTr^ K&                2p2p244l44lf44/ / / / / / / 777777@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`77$$IfTTr^ K&                2p2p244l44lf44/ / / / / / / 777777@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`77$$IfTTr^ K&                2p2p244l44lf44/ / / / / / / 78889$9D9xdP<@$Ifd$a$G$^]`@$Ifd$a$G$^]`@$Ifd$a$G$^]`a$$IfTT&    @ p p 44l44lf44/ / / / @$Ifd$a$^]`@$Ifd$a$G$^]`D9^9`9$$$IfTT\t"&             (p(p(44l44lf44/ / / / / / / 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/ / / / / / <<= ="=|Y<|$Ifdh$a$ `0$7$5$9DG$"$Ifd$a$ `0$7$5$9DG$^]`$$IfTT0,&     pp44l44lf44/ / / / / "=====F)$Ifd$a$ `0$7$5$9DG$$$IfTT0,&     pp44l44lf44/ / / / / $Ifd$a$7$5$9DG$"$Ifd$a$ `0$7$5$9DG$^h]`= >>>>`>B9. $If$a$G$$a$$$IfTT0,&     pp44l44lf44/ / / / / $Ifd$a$ `0$7$5$9DG$$Ifd$a$ `0$7$5$9DG$`>b>>>>lO$Ifdh$a$ `0$7$5$9DG$$Ifdh$a$ `0$7$5$9DG$$If$a$ `0$G$a$$IfTT,&    @ p p 44l44lf44/ / / / >>f??r@nYD/$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$$$IfTT0,&       pp44l44lf44/ / / / / / / r@@@LAAYD/$If$a$ `0$G$$If$a$ `0$G$$$IfTT0,&       pp44l44lf44/ / / / / / / $If$a$ `0$G$ABBBBD/$If$a$ `0$G$$$IfTT0,&       pp44l44lf44/ / / / / / / $If$a$ `0$G$$If$a$ `0$G$BCTCVCXCZCCCl$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$CC0DDEnYD/$If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$$$IfTT0,&       pp44l44lf44/ / / / / / / E0EfEhEED/$If$a$ `0$G$$$IfTT0,&       pp44l44lf44/ / / / / / / $If$a$ `0$G$$If$a$ `0$G$EXFFGGG=4$a$$$IfTT0,&     pp44l44lf44/ / / / / $If$a$ `0$G$$If$a$ `0$G$$If$a$ `0$G$GG$H&HHInJJJKLLMpM"NPPQjRXSzTdd$a$7$5$9D^]`:+ & Fdh^h]`EEdh & Fdh^h]`$a$zTUUUUUUUUdd$a$7$5$9D^]`:+$a$+H$$If,  p p 47474747f44/ $If$a$G$+?<0@PBP/ =!"#2$ 2P1h0p3P(20Root Entry FCompObjjOle 1Table%Data SummaryInformation(WordDocumentADocumentSummaryInformation8 t