Petition by Entrepreneur to Remove Conditions on Permanent Resident Status USCIS Form I-829 Department of Homeland Security U.S. Citizenship and Immigration Services OMB No. 1615-0045 Expires: 03/31/2017 Fee Receipt Received (mm/dd/yyyy) Action Block Resubmitted (mm/dd/yyyy) Relocated (mm/dd/yyyy) For Received (mm/dd/yyyy) USCIS Sent (mm/dd/yyyy) Use Petitioner Interviewed Only Remarks (mm/dd/yyyy) Immigrant Classification DOE/A To be completed by an attorney or accredited representative (if any). Select this box if Form G-28 is attached to represent the petitioner. Attorney State Bar Number (if applicable) Attorney or Accredited Representative USCIS ELIS Account Number (if any) ► START HERE - Type or print legibly in black ink. Part 1. Information About Regional Center Part 3. Information About You 1. 1.a. Family Name (Last Name) 1.b. Given Name (First Name) Was the investment by the entrepreneur associated with an approved regional center? Yes No If you answered “Yes” to Item Number 1., please complete Item Numbers 2.a. - 2.c. 2.a. Name of Regional Center 2.b. Regional Center Identification Number 2.c. Receipt number for the approved Form I-924, Application For Regional Center Under the Immigrant Investor Program, upon which the related Form I-526, Immigrant Petition by Alien Entrepreneur, was based ► Part 2. Basis for Petition Select only one box. 1. I am a conditional permanent resident based on my investment in a commercial enterprise. 2. I am a conditional permanent resident who is the spouse, former spouse, or child of an entrepreneur, and I am filing separately from the entrepreneur's Form I-829. 3. I am a conditional permanent resident spouse or child of an entrepreneur who has died. 1.c. Middle Name 2. Alien Registration Number (A-Number) (if any) ► A- 3. USCIS ELIS Account Number (if any) ► 4. U.S. Social Security Number (if any) ► 5. Form I-526 Receipt Number on which this petition is based ► Other Names You Have Used (including maiden name, nicknames, and aliases, if any) 6.a. Family Name (Last Name) 6.b. Given Name (First Name) 6.c. Middle Name 7.a. Family Name (Last Name) 7.b. Given Name (First Name) 7.c. Middle Name Form I-829 05/07/15 N Page 1 of 11 Part 3. Information About You (continued) Your U.S. Mailing Address Criminal History 15. Since becoming a conditional permanent resident, have you EVER been arrested, cited, charged, indicted, convicted, fined, or imprisoned for violating any law or ordinance (excluding minor traffic violations)? Yes No 16. Since becoming a conditional permanent resident, have you EVER committed any crime for which you were not arrested? Yes No 8.a. In Care Of Name (if any) 8.b. Street Number and Name 8.c. Apt. Ste. Flr. 8.d. City or Town 8.e. State 9. 8.f. ZIP Code Is your mailing address the same as your physical address? Yes No If your mailing address and the address where you currently live (physical address) are not the same, you MUST provide your current physical address in the Item Numbers 10.a. - 10.h. Your Physical Address 10.a. Street Number and Name 10.b. Apt. Ste. Flr. 10.c. City or Town 10.d. State 10.e. ZIP Code 10.f. Province 10.g. Postal Code If you answered “Yes” to Item Number 15., you must provide certified court dispositions, arrest reports, statements of charges, indictment information, or any other charging documents that were issued. If you answered “Yes” to Item Number 16., provide the date and location (town or city/state or province/ country) of the events and provide an explanation in Part 11. Additional Information. Part 4. Information About Your Current Spouse or Your Former Conditional Permanent Resident Spouse 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name 2. Gender 3. A-Number (if any) Male Female ► A- 10.h. Country 4. USCIS ELIS Account Number (if any) ► Other Information About You 5. Date of Birth 11. Date of Birth 12. Gender 13. Country of Birth 6.a. Family Name (Last Name) 6.b. Given Name (First Name) 14. Country of Citizenship or Nationality 6.c. Middle Name (mm/dd/yyyy) Male Female (mm/dd/yyyy) Other Names Used (if applicable) 7.a. Family Name (Last Name) 7.b. Given Name (First Name) 7.c. Middle Name Form I-829 05/07/15 N Page 2 of 11 Part 4. Information About Your Current Spouse or Your Former Conditional Permanent Resident Spouse (continued) Mailing Address Apt. Ste. Flr. 8.f. Child 1 1.c. Middle Name 8.c. City or Town 8.d. State Provide the following information about your children. 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 8.a. Street Number and Name 8.b. Part 5. Information About Your Children 8.e. ZIP Code 2. Gender 3. A-Number (if any) ► A- 4. USCIS ELIS Account Number (if any) ► 5. Date of Birth Province 8.g. Postal Code 8.h. Country 10. Date of Marriage (mm/dd/yyyy) 6.c. Middle Name 11. Date Marriage Terminated Mailing Address (mm/dd/yyyy) 12. Is this spouse currently living with you? Yes No 13. Is this spouse applying with you? Yes No 14. Current Immigration Status (for example, conditional resident, tourist/visitor, entered without inspection) Is the current immigration status of your spouse or former spouse based on your current immigration status? Yes No NOTE: If you have both a current spouse and a former conditional permanent resident spouse, use Part 11. Additional Information to provide this same information about your current spouse or former conditional permanent resident spouse who you did not already include in Part 4. above. Form I-829 05/07/15 N (mm/dd/yyyy) 6.a. Family Name (Last Name) 6.b. Given Name (First Name) Current Spouse Former Conditional Permanent Resident Spouse 15. Female Other Names Used (if applicable) Other Information 9. Male 7.a. Street Number and Name 7.b. Apt. Ste. Flr. 7.c. City or Town 7.d. State 7.f. 7.e. ZIP Code Province 7.g. Postal Code 7.h. Country 8. Is this child currently living with you? Yes No 9. Is this child applying with you? Yes No 10. Current Immigration Status (for example, conditional resident, tourist/visitor, entered without inspection) Page 3 of 11 Child 3 Part 5. Information About Your Children (continued) 21.a. Family Name (Last Name) 21.b. Given Name (First Name) Child 2 11.a. Family Name (Last Name) 11.b. Given Name (First Name) 22. Gender 11.c. Middle Name 23. A-Number (if any) ► A- 24. USCIS ELIS Account Number (if any) ► 25. Date of Birth 21.c. Middle Name 12. Gender 13. A-Number (if any) Male Female ► A14. USCIS ELIS Account Number (if any) ► 15. Date of Birth 26.c. Middle Name Mailing Address 16.c. Middle Name 27.a. Street Number and Name Mailing Address 27.b. 17.a. Street Number and Name 27.c. City or Town Ste. Flr. Apt. 27.d. State 17.c. City or Town 17.d. State (mm/dd/yyyy) 26.a. Family Name (Last Name) 26.b. Given Name (First Name) 16.a. Family Name (Last Name) 16.b. Given Name (First Name) Apt. Female Other Names Used (if applicable) (mm/dd/yyyy) Other Names Used (if applicable) 17.b. Male Ste. Flr. 27.e. ZIP Code 27.f. Province 17.e. ZIP Code 27.g. Postal Code 17.f. Province 27.h. Country 17.g. Postal Code 17.h. Country 18. Is this child currently living with you? Yes No 19. Is this child applying with you? Yes No 20. Current Immigration Status (for example, conditional resident, tourist/visitor, entered without inspection) Form I-829 05/07/15 N 28. Is this child currently living with you? Yes No 29. Is this child applying with you? Yes No 30. Current Immigration Status (for example, conditional resident, tourist/visitor, entered without inspection) Page 4 of 11 If you need extra space to list additional children, use the space provided in Part 11. Additional Information or attach a separate sheet of paper; type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. Part 5. Information About Your Children (continued) Child 4 31.a. Family Name (Last Name) 31.b. Given Name (First Name) Part 6. Your Biographic Information 31.c. Middle Name 32. Gender 33. A-Number (if any) Male 1. Ethnicity (Select only one box) Hispanic or Latino Not Hispanic or Latino 2. Race (Select all applicable boxes) Female ► A34. USCIS ELIS Account Number (if any) ► 35. Date of Birth White Asian Black or African American (mm/dd/yyyy) American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Other Names Used (if applicable) 36.a. Family Name (Last Name) 36.b. Given Name (First Name) 36.c. Middle Name 3. Height 4. Weight 5. Eye Color (Select only one box) Mailing Address 37.a. Street Number and Name 37.b. Apt. 6. Ste. Flr. 37.d. State Inches Pounds Black Gray Blue Brown Green Hazel Maroon Pink Unknown/Other Hair Color (Select only one box) Bald (No hair) Brown Sandy 37.c. City or Town Feet Black Gray White Blond Red Unknown/Other 37.e. ZIP Code Part 7. Information About the New Commercial Enterprise (NCE) 37.f. Province 37.g. Postal Code Type of Enterprise 37.h. Country 38. Is this child currently living with you? Yes No 39. Is this child applying with you? Yes No 40. Current Immigration Status (for example, conditional resident, tourist/visitor, entered without inspection) Form I-829 05/07/15 N 1. NCE formed after November 29, 1990. 2. NCE resulting from the purchase of a business, formed on or before November 29, 1990, that has been restructured or reorganized. 3. NCE resulting from a capital investment in, and substantial expansion of, a business formed on or before November 29, 1990. Page 5 of 11 Part 7. Information About the New Commercial Enterprise (NCE) (continued) Additional Information About the NCE 4. Name of the NCE Subsequent Investments in the NCE Provide the following information about how much the entrepreneur has invested in the NCE since the entrepreneur's initial investment. 17.a. Date of Subsequent Investment (mm/dd/yyyy) 17.b. Amount of Subsequent Investment $ Physical Address 5.a. Street Number and Name 5.b. Apt. Ste. Flr. 5.c. City or Town 5.d. State 5.e. ZIP Code 17.c. Type of Subsequent Investment (for example, cash, equipment, inventory, other tangible property, cash equivalents, or qualifying indebtedness as described in 8 CFR 204.6(e)) NOTE: If multiple investments have been made since the entrepreneur's initial investment in the commercial enterprise, use Part 11. Additional Information to list the dates, amounts, and type of investments. 6. Telephone Number 7. Internet Web site Address (if established) 8. Type of Business Organization (for example, corporation, limited liability company, partnership) 18.a. At the time of the Entrepreneur's Initial Investment 9. Nature of Business (for example, furniture manufacturer) 18.b. Currently Employed in the NCE 10. Included Industries (select North American Industry Classification System (NAICS) code or codes) 11. IRS Tax Identification Number 12. Date Business Established (mm/dd/yyyy) 13. Amount of the Entrepreneur's Initial Investment in the NCE $ 14. Date of the Entrepreneur's Initial Investment (mm/dd/yyyy) 15. What percentage of the NCE does the entrepreneur own? 16. Is this petition based on investment in a troubled business? Yes No Form I-829 05/07/15 N Full-time Positions and Qualifying Employees Provide the number of full-time positions for direct and qualifying employees in the NCE in the United States (excluding you, your spouse, and your children): Job Creation 19.a. How many new direct jobs did the entrepreneur's investment create? 19.b. How many new direct jobs will the entrepreneur's investment create within a reasonable amount of time after filing this petition? 20.a. If the NCE is associated with an approved regional center, how many indirect jobs were created? 20.b. If the NCE is associated with an approved regional center, how many indirect jobs will the NCE create within a reasonable amount of time after filing this petition? 21. If the investment was made into a troubled business, how many jobs were maintained as a result of the investment? Page 6 of 11 Gross and Net Incomes Part 8. Petitioner's Statement, Contact Information, Acknowledgement of Appointment at USCIS Application Support Center, Certification, and Signature Provide the gross and net incomes generated annually by the commercial enterprise since the entrepreneur's initial investment. Include all income generated in the present year to date. NOTE: Read the information on penalties in the Penalties section of the Form I-829 Instructions before completing this part. Part 7. Information About the New Commercial Enterprise (NCE) (continued) 22.a. Year (yyyy) Petitioner's Statement 22.b. Gross Income $ 22.c. Net Income $ NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2. 1.a. I can read and understand English, and have read and understand every question and instruction on this petition, as well as my answer to every question. I have read the Acknowledgement of Appointment at USCIS Application Support Center. 1.b. The interpreter named in Part 9. has read every question and instruction on this petition, as well as my answer to every question, in 23.a. Year (yyyy) 23.b. Gross Income $ 23.c. Net Income $ 24.a. Year (yyyy) 24.b. Gross Income $ 24.c. Net Income $ 25. 26. Has the commercial enterprise filed for bankruptcy, ceased business operations, materially changed the nature of the business, or made any changes in its organization or ownership since the date of the entrepreneur's initial investment? Yes No Has the commercial enterprise sold any corporate assets, shares, or property, or had any capital withdrawn since the date of the entrepreneur's initial investment? Yes , a language in which I am fluent. I understand every question and instruction on this petition as translated to me by my interpreter, and have provided complete, true, and correct responses in the language indicated above. The interpreter named in Part 9. has also read the Acknowledgement of Appointment at USCIS Application Support Center to me, in the language in which I am fluent, and I understand this Application Support Center (ASC) Acknowledgement as read to me by my interpreter. 2. , who is is not an attorney or accredited representative, in preparing this petition for me. This person who assisted me in preparing my petition has reviewed the Acknowledgement of Appointment at USCIS Application Support Center with me, and I understand the ASC Acknowledgement. No NOTE: If you answered “Yes” to Item Number 25. or 26., provide an explanation in Part 11. Additional Information. 27. Provide the total number of EB-5 investors associated with the NCE. 28. Provide the total amount of EB-5 capital invested into the NCE. If you need extra space to provide additional information for any item in Part 7., use the space provided in Part 11. Additional Information or attach a separate sheet of paper; type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. Form I-829 05/07/15 N I have requested the services of and consented to Petitioner's Contact Information 3. Petitioner's Daytime Telephone Number 4. Petitioner's Mobile Phone Number (if any) 5. Petitioner's Email Address (if any) Page 7 of 11 Part 8. Petitioner's Statement, Contact Information, Acknowledgement of Appointment at USCIS Application Support Center, Certification, and Signature (continued) Petitioner's Signature 6.a. Petitioner's Signature 6.b. Date of Signature (mm/dd/yyyy) Acknowledgement of Appointment at USCIS Application Support Center I, , understand that the purpose of a USCIS ASC appointment is for me to provide fingerprints, photograph, and/or signature and to re-affirm that all of the information in my petition is complete, true, and correct and was provided by me. I understand that I will sign my name to the following declaration which USCIS will display to me at the time I provide my fingerprints, photograph, and/or signature during my ASC appointment. By signing here, I declare under penalty of perjury that I have reviewed and understand my application, petition, or request as identified by the receipt number displayed on the screen above, and all supporting documents, applications, petitions, or requests filed with my application, petition, or request that I (or my attorney or accredited representative) filed with USCIS, and that all of the information in these materials is complete, true, and correct. I also understand that when I sign my name, provide my fingerprints, and am photographed at the USCIS ASC, I will be re-affirming that I willingly submit this petition; I have reviewed the contents of this petition; all of the information in my petition and all supporting documents submitted with my petition were provided by me and are complete, true, and correct; and if I was assisted in completing this petition, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS Application Support Center with me. Petitioner's 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 and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek. I furthermore 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. NOTE TO ALL PETITIONERS: If you do not completely fill out this petition or fail to submit required documents listed in the instructions, your petition may be denied. Part 9. Interpreter's Certification, Contact Information, and Signature Provide the following information about the interpreter. Interpreter's Full Name 1.a. Interpreter's Family Name (Last Name) 1.b. Interpreter's Given Name (First Name) 2. Interpreter's Business or Organization Name (if any) Interpreter's Mailing Address 3.a. Street Number and Name 3.b. Apt. Ste. Flr. 3.c. City or Town 3.d. State 3.f. 3.e. ZIP Code Province 3.g. Postal Code 3.h. Country Interpreter's Contact Information 4. Interpreter's Daytime Telephone Number 5. Interpreter's Email Address (if any) I certify, under penalty of perjury, that the information in my petition and any document submitted with my petition were provided by me and are complete, true and correct. Form I-829 05/07/15 N Page 8 of 11 Part 9. Interpreter's Certification, Contact Information, and Signature (continued) Preparer's Mailing Address 3.a. Street Number and Name Interpreter's Certification 3.b. I certify that: 3.c. City or Town I am fluent in English and , which is the same language provided in Part 8., Item Number 1.b.; 3.d. State I have read to this petitioner every question and instruction on this petition, as well as the answer to every question, in the language provided in Part 8., Item Number 1.b.; and I have read the Acknowledgement of Appointment at USCIS Application Support Center to the petitioner in the same language provided in Part 8., Item Number 1.b. The petitioner has informed me that he or she understands every instruction and question on the petition, as well as the answer to every question, and the petitioner verified the accuracy of every answer; and The petitioner has also informed me that he or she understands the ASC Acknowledgement and that by appearing for a USCIS ASC biometric services appointment and providing his or her fingerprints, photograph, and/or signature, he or she is re-affirming that the contents of this petition and all supporting documentation are complete, true, and correct. Interpreter's Signature 6.a. Interpreter's Signature 6.b. Date of Signature (mm/dd/yyyy) Part 10. Contact Information, Statement, Certification, and Signature of the Person Preparing this Petition, If Other Than the Petitioner Provide the following information about the preparer. 3.f. Apt. Ste. Flr. 3.e. ZIP Code Province 3.g. Postal Code 3.h. Country Preparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparer's Fax Number (if any) 6. Preparer's Email Address (if any) Preparer's Statement 7.a. I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and with the petitioner's consent. 7.b. I am an attorney or accredited representative and my representation of the petitioner in this case extends does not extend beyond the preparation of this petition. NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this petition, you must submit a completed Form G-28, Notice of Attorney or Accredited Representative, with this petition. Preparer's Full Name 1.a. Preparer's Family Name (Last Name) 1.b. Preparer's Given Name (First Name) 2. Preparer's Business or Organization Name (if any) Form I-829 05/07/15 N Page 9 of 11 Part 10. Contact Information, Statement, Certification, and Signature of the Person Preparing this Petition, If Other Than the Petitioner (continued) Preparer's Certification By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this petition on behalf of, at the request of, and with the express consent of the petitioner. I completed this petition based only on responses the petitioner provided to me. After completing the petition, I reviewed it and all of the petitioner's responses with the petitioner, who agreed with every answer on the petition. If the petitioner supplied additional information concerning a question on the petition, I recorded it on the petition. I have also read the Acknowledgement of Appointment at USCIS Application Support Center to the petitioner and the petitioner has informed me that he or she understands the ASC Acknowledgement. Preparer's Signature 8.a. Preparer's Signature 8.b. Date of Signature (mm/dd/yyyy) Form I-829 05/07/15 N Page 10 of 11 5.a. Page Number Part 11. Additional Information If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. 5.b. Part Number 5.c. Item Number 6.b. Part Number 6.c. Item Number 5.d. 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name 2. A-Number (if any) ► A- 3.a. Page Number 3.b. Part Number 3.c. Item Number 6.d. 3.d. 4.a. Page Number 6.a. Page Number 4.b. Part Number 4.c. Item Number 4.d. Form I-829 05/07/15 N Page 11 of 11