This document is a petition for a visa submitted by a dependent of a principal alien. It contains biographical information about the applicant such as name, date and place of birth, current immigration status, and relationship to the principal alien. It also includes a request for an adjustment to permanent resident status based on the applicant's previous arrival in the United States as a nonimmigrant or parolee.

1. 





































 





 

 



 

 




 
 



 


 


 

 


 



 
 

 




2. 

 
 










 


 
   
 


   
   
   
   
   
   
   
   
   
   
 
 
 
 
 

3. 





 




 



 







 









 
 



 
 
 
 
 
 
 
 
 
 

4. 













 


 



 














 



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

5. 
 


























 



 
 
 



 


6. 




 










 














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