1. hobbies and interests
2. games
3. lottery

1416 2nd Street
Santa Monica, CA 90401
T (310) 570-4088
F (310) 570-4080
[email protected]
NAVIGATING IM M IGRATION
Re: 2014 Diversity Visa “Green Card” Lottery Program.
Dear Client:
I am writing to advise that the registration period for the 2014 Diversity Immigrant Visa Lottery will start
on October 2, 2012 and will end at noon, Eastern Standard Time (EST) on November 3, 2012. The process time this
year has been shortened and will only run 4 weeks. To process your application, we require the following be
completed and returned to our office at your earliest convenience.
1.
Service Contract: Please review, complete and sign.
2.
Legal Fee: As indicated on Page 1 of the Data Sheet, this may be paid via check, money order or
credit card (Mastercard, Visa or American Express).
3.
Data Sheet (4 pages): Please complete all sections and sign. If you are applying as a married
couple, only one Data Sheet is required. We will process one application for each spouse.
4.
Photographs (2 photographs per person): The photo requirements for the DV Lottery are
complex, requiring digitized photos meeting very exact specifications. Our office will scan your
hard copy photos to ensure they meet Department of State specifications. Therefore, please
provide two recent passport style photographs of yourself, your spouse and each child, including
all natural children as well as all legally-adopted and stepchildren, who are unmarried and under
the age of 21 years, even if you are no longer married to the child’s parent, and even if the child
does not currently reside with you and/or will not immigrate with you. The size of these
photographs must be 2 inches square, or 50 x 50 mm, facing forward. Color or black and white
photographs are acceptable. The photo background must be plain white or off-white. You must
print the full name and date of birth of each family member on the back of each photo.
*** Signature sheets are no longer required for the Diversity Lottery Program***
We must receive all of the above items in order to process and file your application for the DV 2014 Visa
Program. Should you have any further questions, please do not hesitate to contact the Lottery Department at (310)
570-4088 or email at: [email protected].
Sincerely,
Bernard P. Wolfsdorf
BERNARD P. WOLFSDORF
Attorney at Law
SERVICE AGREEMENT
Please review this service agreement carefully, and if satisfactory, sign and return it together with your retainer.
This Service Agreement is made on _______________ (date) between the Client (the term “Client” includes the
undersigned, sponsor, petitioner, beneficiary, employer or agent of these parties) and Bernard P. Wolfsdorf, a
Professional Law Corporation (hereinafter the “Attorney”).
1. The Client hereby retains the said Attorney to prepare and submit an application for the Diversity
Immigrant (DV) Program for ___________________________________________ (please print or type name).
2. The Client hereby agrees to pay to said Attorney the total legal fee of -- a) $100 for one adult applicant, or
b) $150 for a married couple (exclusive of miscellaneous charges such as government filing fee, photocopies, long
distance/overseas telephone calls, mail, courier, and international facsimiles). Late Applications, (those received
within the last 10 days of the close of registration program), will be charged a $50 rush fee. To submit an application
for the Diversity Lottery Program, payment to be made as follows: a non-refundable retainer in the amount of
total legal fee due upon commencement of the case.
3. The Client understands and agrees that the above-mentioned fees relate to preparing and filing the
application only and does not include work performed such as immigrant visa processing at a Consulate
abroad or adjustment of status in the United States. Retaining said Attorney for such additional services after
successful selection is optional for client. The agreement does not include any legal services in connection with any
expedite or appeal, nor does it include services concerning rescheduling of interviews, overcoming grounds of
removal or obtaining waivers of ineligibility for any reason including overstays. Legal services are limited only to
those listed in this agreement based on the law and facts in effect as of the date of this agreement.
4. If there is any disagreement or dispute between the Client and the Attorney concerning fees, this retainer
agreement, or any other claim which arises out of our representation of you, it is hereby agreed such dispute will be
submitted to binding arbitration under Section 1280 of the Code of Civil Procedure of the State of California relating
to arbitration of contract disputes. The prevailing party shall be entitled to reasonable attorney's fees and costs
incurred in such arbitration. Client and undersigned agree that this contract shall be governed and construed
according to the law of California, which shall have exclusive jurisdiction in regard to matters arising from this
Agreement.
5. That both Attorney and the Client will use their best efforts in furthering the purposes of the Agreement but
the Client understands and agrees that the fees set forth are payable in full at the times indicated above and that
Attorney is entitled to cease providing services if fees are outstanding. Client understands that the DV Program
regulations provide for random selection and, therefore, results are unpredictable. Fees are deemed due whether
Attorney is or is not successful in his efforts on behalf of the Client, and that no assurances or guarantee of success
has been given or requested, the fees being fully earned solely by the Attorney furnishing his best efforts in the
Client’s behalf. If client withdraws from the case after the file has been opened by the Attorney no refund need be
paid and any unpaid costs or outstanding fees shall be due and payable.
6.
Client agrees that the fees paid pursuant to this Agreement will be deposited in our general account for our
use.
Service Agreement Executed by:
Bernard P. Wolfsdorf
__________________________________
x_________________________________
BERNARD P. WOLFSDORF
(signature)
Attorney at Law
Client
DV Green Card Lottery Data Sheet
(Page 1 of 4 – Please type or print neatly.)
PAYMENT INFORMATION
LEGAL FEE (Check one box):  $100 for one adult applicant
(for principal applicant only)
Payment enclosed (Check one box):
or  $150 for a married couple
(for principal applicant & spouse)
 U.S. Money Order or Cashier’s Check
 International Money Order
 Personal or Business Check Drawn on U.S. Bank
Applicant’s Name ______________________________________________________________________________________
Charge to Credit Card:
 MasterCard or  VISA or  American Express
(Please note: We accept only these credit cards.)
Card #______________________________________________________________ Expire date_________________________
Cardholder sign here
X _______________________________________________________________________________
PRINT Cardholder Name _________________________________________________________________________________
Cardholder’s Billing Address ______________________________________________________________________________
_______________________________________________________________________________
Cardholder’s Home Telephone _________________________________ Work Telephone _____________________________
*
*
*
*
*
I have read the information provided by Bernard P. Wolfsdorf, a Professional Law Corporation (Attorney) concerning the Diversity
Immigrant Visa (DV) Program (pursuant to Section 203(c) of the Immigration and Nationality Act) and agree to provide accurate
information.
I understand that there is no guarantee that I will be successful in this application and that Attorney will undertake his best efforts on
my behalf.
I nevertheless wish to apply, and I also understand that the representation provided will be limited to submission of the application
only. If additionally retained, further services relating to immigrant visa processing or adjustment of status may be provided.
I have read and fully understand the contents of this agreement, and I accept these terms of limited representation.
X _______________________________________________________________
PRINCIPAL APPLICANT (signature)
__________________________________
DATE
BERNARD P. WOLFSDORF - LOTTERY - 310-570-4088
DV Green Card Lottery Data Sheet
(Page 2 of 4 – Please type or print neatly.)
Feel free to duplicate the Data Sheet and Service Agreement.
Return the completed Data Sheet, photographs, signed Service Agreement and payment to:
Law Offices of Bernard P. Wolfsdorf, 1416 2 ND STREET, SANTA MONICA, CA 90401 • USA
(310) 570-4088 • FAX: (310) 570-4080 • E-mail: [email protected] • Web Site: http://www.wolfsdorf.com
CONTACT INFORMATION - Please inform us of any changes.
Your Name_________________________________________________________________________________________________
Your Address________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Your Home Telephone ____________________________
Your Work Telephone ______________________________________
Your FAX
Your E-mail Address ______________________________________
____________________________________
E-mail Address IS REQUIRED!!
SECONDARY CONTACT INFORMATION
(This should be a relative or friend who will always know where to contact you, preferably someone in the United States.
Please let them know that our office may be in contact with them.)
Secondary Contact Name______________________________________________________________________________________
Secondary Contact Address_____________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Secondary Home Telephone ___________________________ Secondary Work Telephone_________________________________
Secondary FAX _____________________________________ Secondary E-mail Address________________________________
Please send all correspondence to:  My address
 My E-mail address
 Secondary Contact address
REFERRAL SOURCE
(How you heard about our office.)
 I am currently a client of your law firm.
 I am a prior client of your law firm.
 Advertisement in ___________________________________  My associate/friend __________________________________
(Name of Publication)
(Provide full name)
 My employer ______________________________________  My school _________________________________________
(Company Name)
(Name of school)
 Other:________________________________________________________________________
BERNARD P. WOLFSDORF - LOTTERY - 310-570-4088
DV Green Card Lottery Data Sheet
(Page 3 of 4 – Please type or print neatly.)
The State Department has established processing criteria that can affect the success of your DV application. Please read the
following instructions carefully, and provide ALL information as requested.
Current DV regulations require complete biographic details of yourself, your spouse (regardless of
immigration or marital status), and all natural children, as well as all legally-adopted and stepchildren, who are unmarried and
under the age of 21 years, even if you are no longer legally married to the child’s parent and even if the child does not
currently reside with you and/or will not immigrate with you.
Provide full legal names as listed on birth certificates, or current legal names as documented by
a marriage certificate or other court document.
FAILURE TO PROVIDE COMPLETE INFORMATION WILL DISQUALIFY YOUR APPLICATION.
Therefore, it is vital that you include ALL immediate family members on the Data Sheet, and answer all questions completely. Any mistakes
may result in disqualification, therefore all information must be clearly readable and accurate.
Please note that we request date of birth in order of Month, Day and Year.
Should you have any questions, please contact the Lottery Department at (310) 570-4088.
1. PRINCIPAL APPLICANT -- Last Name: ________________ First Name: ______________
2. Date of Birth: (D)____ / (M)____/ (Y)______
Middle Name(s): __________
3. Place of Birth: _______________________
(Example: Day / Month/ Year)
(City/State)
_______________________
(Country)
4. Education of Principal Applicant:
5. Gender:  Male
 Female
a. Highest level of education you have achieved, as of today. Please choose from one of ten options:
 primary school  high school, no degree
 high school degree
 vocational school  some university courses
 university degree
 some graduate level courses
 master degree  some doctorate level course  doctorate degree
b. I have the equivalent of a high school education.
 Yes
 No
6. Marital Status:  Single (Never married)
 Married
 Widowed
 Divorced
 Separated
7. Current Immigration Status (if applicable) ______________
8. Last or current residence outside of the U.S.: ___________________________________________________________________
(City, Province, Country)
9. Country where you live today: _____________________________
10. SPOUSE -- Last Name: _______________
First Name: ________________ Middle Name(s): ___________
11. Date of Birth: (D)____ / (M)____/ (Y)______ 12. Place of Birth: ________________ __________________
13. Education of Spouse:
14. Gender:  Male
 Female
a. Highest level of education you have achieved, as of today. Please choose from one of ten options:
 primary school  high school, no degree
 high school degree
 vocational school  some university courses
 university degree
 some graduate level courses
 master degree  some doctorate level course  doctorate degree
b. I have the equivalent of a high school education.
 Yes
 No
15. Immigration Status of Spouse:  U.S. Citizen
 Lawful Permanent Resident (has green card)
 ____________
16. Last or current residence outside of the U.S.: __________________________________________________________________
(City, Province, Country)
** Please remember to include two passport style photos (2 inches square, or 50 x 50 mm) **
** of yourself, two photos of your spouse and two photos of each child when returning these forms.**
CHILDREN
 I/We do not have any children.
 I/We have listed ALL children who are unmarried and under the age of 21 years.
DV Green Card Lottery Data Sheet
(Page 4 of 4 – Please type or print neatly.)
CHILDREN (continued)
(If you have more than 5 children, please make an extra copy of this page.)
ALL children who are unmarried and under the age of 21 years must be included on the Diversity Visa Lottery Application. Should
you or your spouse be selected as a winning applicant, please be aware that children over the age of 21 years will not be eligible to
immigrant visa process for a derivative green card. Any persons over the age of 21 wishing to enter the Diversity Visa Lottery should
submit an individual application where he/she is listed as the Principal Applicant.
If your child’s 21st birthday occurs before final green card approval, this child cannot be granted a derivative green card. We strongly
recommend submitting an individual application where he/she is listed as the Principal Applicant.
If any of your children will complete high school by October of the DV fiscal year, we suggest submitting an individual application as
well – doubling their chance of selection.
Please send me _____ additional DV Lottery packages so my children may also submit individual applications.
15. CHILD -- Male ____ Female ____ Last Name: _______________________________________________________________
First Name: ___________________________________
16. Date of Birth: (D)____ / (M)____/ (Y)______
Middle Name(s): __________________________________________
3. Place of Birth: _______________________
(Example: Day / Month/ Year)
(City/State)
_______________________
(Country)
18. CHILD -- Male ____ Female ____ Last Name: _______________________________________________________________
First Name: ___________________________________
19. Date of Birth: (D)____ / (M)____/ (Y)______
Middle Name(s): __________________________________________
3. Place of Birth: _______________________
(Example: Day / Month/ Year)
(City/State)
_______________________
(Country)
21. CHILD -- Male ____ Female ____ Last Name: _______________________________________________________________
First Name: ___________________________________
22. Date of Birth: (D)____ / (M)____/ (Y)______
Middle Name(s): __________________________________________
3. Place of Birth: _______________________
(Example: Day / Month/ Year)
(City/State)
_______________________
(Country)
24. CHILD -- Male ____ Female ____ Last Name: _______________________________________________________________
First Name: ___________________________________
25. Date of Birth: (D)____ / (M)____/ (Y)______
Middle Name(s): ___________________________________________
3. Place of Birth: _______________________
(Example: Day / Month/ Year)
(City/State)
_______________________
(Country)
27. CHILD -- Male ____ Female ____ Last Name: _______________________________________________________________
First Name: ___________________________________
28. Date of Birth: (D)____ / (M)____/ (Y)______
(Example: Day / Month/ Year)
Middle Name(s): __________________________________________
3. Place of Birth: _______________________
(City/State)
_______________________
(Country)