OMB No. 1615-0026; Exp. 09/30/2016 Form I-526, Immigrant Petition by Alien Entrepreneur Department of Homeland Security U.S. Citizenship and Immigration Services Do Not Write in This Block - For USCIS Use Only (Except G-28 Block Below) Action Block Classification Fee Receipt Priority Date To be completed by Attorney or Representative, if any G-28 is attached Attorney's State License No. Remarks: START HERE - Type or print in black ink. Part 1. Information About You Family Name Given Name Middle Name Address - In Care of Name, if applicable Street Number and Name Apt. Number City State or Province Country Date of Birth (mm/dd/yyyy) Country of Birth Social Security Number (if any) If you are in the United States, provide the following information: Date of Arrival (mm/dd/yyyy) I-94 Number Zip/Postal Code A-Number (if any) Passport Number Travel Document Number Expiration Date for Passport or Travel Document Country of Issuance for Passport or Travel Document Current Nonimmigrant Status Date Current Status Expires (mm/dd/yyyy) Part 2. a. b. c. Part 3. Daytime Telephone Number (with Area Code) Application Type (Check one) This petition is based on an investment in a commercial enterprise in a targeted employment area for which the required amount of capital invested has been adjusted downward. This petition is based on an investment in a commercial enterprise in an area for which the required amount of capital invested has been adjusted upward. This petition is based on an investment in a commercial enterprise that is not in either a targeted area or in an upward adjustment area. Information About Your Investment Name of commercial enterprise in which funds are invested (Required Field - Do Not Leave Blank) Street Address Phone Number with Area Code Business organized as (corporation, partnership, etc.) RECEIVED: ________________ RESUBMITTED: ____________ RELOCATED: SENT ________________ REC'D ____________ Form I-526 (09/24/13) N Part 3. Information About Your Investment (Continued) Kind of business (e.g. furniture manufacturer) Date established (mm/dd/yyyy) Amount of your initial investment Date of your initial investment (mm/dd/yyyy) Your total capital investment in the enterprise to date IRS Tax # $ Percentage of the enterprise you own $ If you are not the sole investor in the new commercial enterprise, list on separate paper the names of all other parties (natural and nonnatural) who hold a percentage share of ownership of the new enterprise and indicate whether any of these parties is seeking classification as an alien entrepreneur. Include the name, percentage of ownership, and whether or not the person is seeking classification under section 203(b)(5). NOTE: A "natural" party would be an individual person, and a "non-natural" party would be an entity such as a corporation, consortium, investment group, partnership, etc. If you indicated in Part 2 that the enterprise is in a targeted employment area or in an upward adjustment area, name the county and State: Part 4. County State Additional Information About the Enterprise Type of Enterprise (check one): New commercial enterprise resulting from the creation of a new business. New commercial enterprise resulting from the purchase of an existing business. New commercial enterprise resulting from a capital investment in an existing business. Composition of the Petitioner's Investment: Total amount in U.S. bank account ...................................................................................... $ Total value of all assets purchased for use in the enterprise................................................. $ Total value of all property transferred from abroad to the new enterprise........................... $ Total of all debt financing.................................................................................................... $ Total stock purchases........................................................................................................... $ Other (explain on separate paper)........................................................................................ $ Total $ Income: When you made the investment......... Gross $ Net $ Now.................................................... Gross $ Net $ Gross $ Now $ Net worth: When you made investment............... Form I-526 (09/24/13) N Page 2 Part 5. Employment Creation Information Number of full-time employees in the enterprise in U.S. (excluding you, your spouse, sons, and daughters) When you made your initial investment? Now Difference How many of these new jobs were created by your investment? How many additional new jobs will be created by your additional investment? What is your position, office, or title with the new commercial enterprise? Briefly describe your duties, activities, and responsibilities. What is your salary? Part 6. What is the cost of your benefits? $ $ Processing Information Check One: The person named in Part 1 is now in the United States, and an application to adjust status to permanent resident will be filed if this petition is approved. If the petition is approved and the person named in Part 1 wishes to apply for an immigrant visa abroad, complete the following for that person: Country of nationality: Country of current residence or, if now in the United States, last permanent residence abroad: If you provided a United States address in Part 1, print the person's foreign address: If the person's native alphabet is other than Roman letters, write the foreign address in the native alphabet: Are you in deportation or removal proceedings? Yes (Explain on separate paper) No Have you ever worked in the United States without permission? Yes (Explain on separate paper) No Part 7. Signature Read the information on penalties in the instructions before completing this section. I certify, under penalty of perjury under the laws of the United States of America, that this petition and the evidence submitted with it is all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking. Signature Date Mobile Phone Number ( ) - E-Mail Address NOTE: If you do not completely fill out this form or fail to the submit the required documents listed in the instructions, you may not be found eligible for the immigration benefit you are seeking and this petition may be denied. Part 8. Signature of Person Preparing Form, If Other Than Above (Sign below) I declare that I prepared this application at the request of the above person, and it is based on all information of which I have knowledge. Print Your Signature Date Name Daytime phone # Firm Name with area code Address Form I-526 (09/24/13) N Page 3