I-600 Petition to Classify Orphan as an Immediate Relative and

OMB No. 1615-0028; Expires 09/30/09

I-600, Petition to Classify Orphan
as an Immediate Relative

Department of Homeland Security
U.S. Citizenship and Immigration Services

Do not write in this block.

(For USCIS Use Only)

TO THE U.S. SECRETARY OF STATE:
The petition was filed by:
Married petitioner
Unmarried petitioner

Fee Stamp

The petition is approved for orphan:
Adopted abroad

Coming to U.S. for adoption.
Preadoption requirements have been
met.

Remarks:

File number

DATE OF
ACTION
DD
DISTRICT

Type or print legibly in black ink. Complete a separate petition for each child.
Petition is being made to classify the named orphan as an immediate relative.

Block I - Information About Petitioner
1. My name is: (Last)

8. If you are now married, give the following information:

(First)

(Middle)

2. Other names used (including maiden name if appropriate):
3. I reside in the U.S. at:
(Number and Street)

(c/o if appropriate)
(Town or City)

4. Address Abroad (if any): (Number and Street)
(Town or city)

(Province)

Name of present spouse (include maiden name of wife)
(Apt. No.)

(State) (Zip Code)

Date of birth of spouse (mm/dd/yyyy) Place of birth of spouse
Number of prior marriages of spouse

(Apt. No.)

My spouse resides

(Country)

(Apt. No.) (No. and Street)

With me

Apart from me
(provide address below)

(City)

(State) (Country)

9. I am a citizen of the United States through:

5. I was born on: (mm/dd/yyyy)
In: (Town or City)

Date and place of present marriage (mm/dd/yyyy)

(State or Province)

(Country)

Birth
Parents
Naturalization
If acquired through naturalization, give name under which naturalized,
number of naturalization certificate, and date and place of naturalization:

6. My telephone number is: (include area code)
7. My marital status is:

If not, submit evidence of citizenship. See page one of the instructions.

Married

If acquired through parentage, have you obtained a certificate in your
own name based on that acquisition?
No
Yes

Widowed
Divorced
Single
I have never been married.
I have been previously married
Received

Trans. In

Ret'd Trans. Out

time(s).

Have you or any person through whom you claimed citizenship ever lost
your U.S. citizenship?
No
Yes (If Yes, attach detailed explanation.)

Completed

Form I-600 (Rev.11/19/09)Y

Block II - Information About Orphan Beneficiary
(First)

(Middle)

(Last)

11. Name at Present (First)

(Middle)

(Last)

10. Name at Birth

20. To petitioner's knowledge, does the orphan have any physical or mental
affliction?
Yes
No
If "Yes," name the affliction.

12. Any other names by which orphan is or was known.

21. Who has legal custody of the child?

13. Gender

22. Name of child welfare agency, if any, assisting in this case.

Male
Female

15. Place of Birth (City)

14. Date of birth (mm/dd/yyyy)
(State or Province)

23. Name of attorney abroad, if any, representing petitioner in this case.

(Country)

16. The beneficiary is an orphan because (check one):
He or she has no parents.
He or she has only one parent who is the sole or surviving parent.
17. If the orphan has only one parent, answer the following:
a. State what has become of the other parent:
b. Is the remaining parent capable of providing for the orphan's
support?
Yes
No
c. Has the remaining parent in writing irrevocably released the
orphan for emigration and adoption?
Yes
No
18. Has the orphan been adopted abroad by the petitioner and spouse
jointly or the unmarried petitioner?
Yes
No
If yes, did the petitioner and spouse or unmarried petitioner
personally see and observe the child prior to or during the
adoption proceedings?
Yes
No
Date of adoption (mm/dd/yyyy)

Address of above.
24. Address in the United States where orphan will reside.
25. Present address of orphan.
25. If orphan is residing in an institution, give full name of institution.
26. If orphan is not residing in an institution, give full name of person with
with whom residing.
27. Give any additional information necessary to locate orphan, such as
name of district, section, zone, or locality in which orphan resides.

Place of adoption
19. If either answer in Question 18 is "No," answer the following:
a. Does the petitioner and spouse jointly or does the unmarried
petitioner intend to adopt the orphan in the United States?
Yes
No
b.
Have the preadoption requirements, if any, of the orphan's
proposed State of residence been met?
Yes
No
c.
If b is answered "No," will they be met later?
Yes
No

28. Location of U.S. Embassy or consulate where application for visa
will be made.
(City in Foreign Country)

(Foreign Country)

Certification of Petitioner

Certification of Married Prospective Petitioner's Spouse

I certify, under penalty of perjury under the laws of the United States of
America, that the foregoing is true and correct and that I will care for an
orphan or orphans properly if admitted to the United States.

I certify, under penalty of perjury under the laws of the United States of
America, that the foregoing is true and correct and that my spouse and I
will care for an orphan or orphans properly if admitted to the United States.

(Signature of Petitioner)

(Signature of Petitioner)

Executed on (Date)

Executed on (Date)

Signature of Person Preparing Form, If Other Than Petitioner
I declare that this document was prepared by me at the request of the petitioner and is
based entirely on information of which I have knowledge.
(Signature)
Street Address and Room or Suite No./City/State/Zip Code
Executed on (Date)

Form I-600 (Rev.11/19/09)Y Page 2