TABLE OF CHANGES – FORM
Form I-600, Petition to Classify Orphan as an Immediate Relative
OMB Number: 1615-0028
05/28/2020
Reason for Revision: Fee Rule Final Rule. Project Phase: G-1056
Legend for Proposed Text:
Expires 12/31/2021 Edition Date 12/21/2019 |
Current Page Number and Section |
Current Text |
Proposed Text |
Page 1, For U.S. Government Use Only |
[Page 1]
For U.S. Government Use Only
[Column 1] The petitioner is: Married Unmarried
[] Form I-600A Approval Approval Valid Until (mm/dd/yyyy):
The petitioner is approved to adopt an orphan from (if specified): (Name of non-Hague Convention Country) :
[] PAIR Letter Issued Date (if applicable) (mm/dd/yyyy) :
[Column 2] Action Block
Department of State Actions: [] Approved [] Transfer to USCIS as Not Clearly Approvable [] Transfer to USCIS as Consular Return
[Column 3] Receipt/Fee Stamp
Final Adjudicating Office/Post: Officer Signature and Date: Child’s Legal Name after Adoption:
To be Completed By an Attorney or Accredited Representative (if any). Select this box if Form G-28 or Form G-28I is attached. Attorney State Bar Number (if applicable): Attorney or Accredited Representative USCIS Online Account Number (if any)
START HERE - Type or print legibly in black ink. Complete a separate petition for each child. This petition is made to classify the named orphan as your immediate relative.
You must be a U.S. citizen in order to file this petition. See the What Are the Eligibility Requirements section of the Form I-600 Instructions for more information.
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[Page 1]
For U.S. Government Use Only
[Column 1] The petitioner is: Married Unmarried
[] Form I-600A Approval Approval Valid Until (mm/dd/yyyy):
The petitioner is approved to adopt an orphan from (if specified): (Name of non-Hague Country) :
[] PAIR Letter Issued Date (mm/dd/yyyy) :
[Column 2] Action Block
Department of State Actions: [] Approved [] Transfer to USCIS as Not Clearly Approvable [] Transfer to USCIS as Consular Return
[Column 3] Receipt/Fee Stamp
Final Adjudicating Office/Post: Officer Signature and Date: Child’s Legal Name after Adoption:
To be Completed by an Attorney or Accredited Representative. Select this box if Form G-28 or Form G-28I is attached. Attorney State Bar Number: Attorney or Accredited Representative USCIS Online Account Number
START HERE - Type or print in black ink. Complete a separate petition for each child. This petition is used to determine if a child is an orphan and eligible to be classified as your immediate relative.
You must be a U.S. citizen to file this petition. See the What Are the Eligibility Requirements section of the Form I-600 Instructions for more information.
Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been married and the question asks, “Provide the name of your current spouse”), type or print “N/A” unless otherwise directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many children do you have?” or “How many times have you departed the United States?”), type or print “None” unless otherwise directed.
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Page 1, Information About You (Petitioner) |
Part 1. Information About You (Petitioner)
1. Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
2. Other Names Used
Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information.
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
Your Contact Information
3. U.S. Mailing Address (if any) In Care Of Name Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code
4. Is your current U.S. mailing address the same as your U.S. physical address? Y/N
If you answered "No," provide your U.S. physical address in Item Number 5. or your address abroad in Item Number 6., as appropriate.
5. U.S. Physical Address (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code
[Page 2]
6. Address Abroad (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State Province Postal Code Country
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7. Your Daytime Telephone Number 8. Your Mobile Telephone Number (if any) 9. Your Email Address (if any)
Information About Your U.S. Citizenship
10. USCIS Online Account Number (if any)
11. Date of Birth
(mm/dd/yyyy) 12. City/Town/Village of Birth
13. State or Province of Birth
14. Country of Birth
15.
How did you obtain your U.S.
citizenship?
A. If you acquired your citizenship through your parents, have you obtained a Certificate of Citizenship in your own name? Yes/No
If you answered "Yes," provide the following information about your Certificate of Citizenship:
Your Name On The Certificate of Citizenship
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
Alien Registration Number (A-Number) (if any)
Certificate of Citizenship Number
Date of Issuance (mm/dd/yyyy)
Place of Issuance
B. If you obtained your citizenship through naturalization, provide the following information about your Certificate of Naturalization:
Your Name On The Certificate of Naturalization
Family Name (Last Name)
A-Number (if any) Certificate of Naturalization
Number Date of Naturalization (mm/dd/yyyy)
Place of Naturalization
16. Have you EVER renounced or lost U.S. citizenship or has anyone you obtained citizenship through (such as your parent or grandparent) EVER lost U.S. citizenship? Yes/No
NOTE: If you answered “Yes”, provide a detailed explanation in the space provided in Part 10. Additional Information.
17. What is your marital status? Single Married Separated Divorced Widowed
18. How many times have you been married (including your current marriage, if applicable)?
NOTE: If you are not currently married, skip to Item Number 29.
[New]
Information About Your Current Marriage
19. Date of Current Marriage (mm/dd/yyyy)
20. Place Where Current Marriage Occurred
21. Name of Your Current Spouse Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
22. Other Names Your Current Spouse Has Used (if any)
Provide all other names your spouse has ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information.
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
23. Information About Your Current Spouse
Spouse’s Date of Birth
(mm/dd/yyyy) Spouse’s USCIS Online Account
Number (if any)
Is your spouse a U.S. citizen? Yes/No
If you answered “Yes,” how did your spouse obtain U.S. citizenship? Birth Naturalization Parents
If you answered “No,” provide your spouse’s current U.S. immigration status:
24. How many times has your current spouse been married (including your current marriage, if applicable)?
Your Spouse’s Contact Information
25. Does your current spouse reside with you? Yes/No
If you answered “No”, provide your current spouse’s physical address in Item Number 26.
26. Your Current Spouse's
Physical Address (if applicable)
27. Your Spouse’s Daytime Telephone Number 28. Your Spouse’s Mobile Telephone Number (if any) 29. Your Spouse’s Email Address (if any)
Additional Household Members
Information About Prior Filings or Adoptions
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Part 1. Information About You (Petitioner)
1. Family Name (Last
Name) 2. Other Names Used
Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 13. Additional Information.
Your Contact Information
3. U.S. Mailing Address [Page 2]
4. Is your current U.S. mailing address the same as your physical residence? Yes/No
If you answered "No” to Item Number 4., provide the address for your U.S. residence in Item Number 5. or the address for your residence abroad in Item Number 6., as appropriate.
5. Address
of U.S. Residence
6. Address of
Residence Abroad
7. Which address would you like USCIS to use for mailing notices and decisions to you? [] U.S. Mailing Address [] Address of Residence Abroad
8. Your Daytime Telephone Number 9. Your Mobile Telephone Number 10. Your Email Address
Information About Your U.S. Citizenship
11. USCIS Online Account Number
12.
Date of Birth (mm/dd/yyyy) 13.
City/Town/Village of Birth 14.
State or Province of Birth 15. Country of Birth
[Page 3]
16.
How did you obtain your U.S.
citizenship? A. If you obtained your citizenship through your parents, have you obtained a Certificate of Citizenship in your own name? Yes/No
If you answered "Yes," provide the following information about your Certificate of Citizenship:
Your Name On The Certificate of Citizenship
Family Name (Last Name) Alien Registration Number (A-Number)
Certificate of Citizenship Number
Date of Issuance (mm/dd/yyyy) Place of Issuance
B. If you obtained your citizenship through naturalization, provide the following information about your Certificate of Naturalization:
Your Name On The Certificate of
Naturalization Family Name (Last Name)
Certificate of Naturalization
Number Date of Naturalization (mm/dd/yyyy)
Place of Naturalization
17. Have you EVER renounced or lost U.S. citizenship or has anyone you obtained citizenship through (such as your parent or grandparent) EVER lost U.S. citizenship? Yes/No
NOTE: If you answered “Yes” to Item Number 17., provide a detailed explanation in the space provided in Part 13. Additional Information.
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Your Duty of Disclosure
You must answer the following questions. See the Duty of Disclosure section in the Form I-600 Instructions concerning your ongoing duty to disclose information in response to these questions. If you answer "Yes" to any of the questions, provide a certified copy of the documentation showing the final disposition of each incident which resulted in arrest, indictment, conviction, and/or any other judicial or administrative action and a written statement giving details, including any mitigating circumstances about each arrest, signed by you under penalty of perjury under U.S. law. The written statement must show the date of each incident; place each incident occurred (city/town, state/province, country); name of police department or other law enforcement administration or other entity involved; and date of incarceration and name of facility. Provide a description of any type of counseling, rehabilitation, or other information that you would like considered in light of this history.
18.
Have you EVER,
whether in or outside the United States: A. Been investigated, arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance? (Answer “Yes,” even if the record of the arrest, conviction, or other criminal history was expunged, sealed, pardoned, or the subject of any other amelioration. Do not include parking or traffic violations, except for violations for driving or operating a vehicle while intoxicated, or while impaired by, or under the influence of, alcohol or another intoxicant.) Yes No
B.
Received a pardon, amnesty, rehabilitation decree, other act of
clemency, or similar action? Yes No [Page 4]
C. Received a suspended sentence, been placed on probation or parole, or been in an alternative sentencing or rehabilitation program, such as diversion, deferred prosecution, deferred or withheld adjudication, or expungement of a criminal charge? Yes No
D.
Been the subject of any investigation at any time even if closed
or unsubstantiated, by any child welfare agency, court, or other
official authority in any state or foreign country concerning the
abuse or neglect of any child? Yes No Information About Your Marital Status
19. What is your marital status? Single Married Separated Divorced Widowed
20. How many times have you been married (including your current marriage)?
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Information About Your Current Marriage
19. Date of Current Marriage (mm/dd/yyyy)
20. Place Where Current Marriage Occurred
21. Name of Your Current Spouse Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
22. Other Names Your Current Spouse Has Used (if any)
Provide all other names your spouse has ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information.
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
23. Information About Your Current Spouse
Spouse’s Date of Birth
(mm/dd/yyyy) Spouse’s USCIS Online Account
Number (if any)
Is your spouse a U.S. citizen? Yes/No
If you answered “Yes,” how did your spouse obtain U.S. citizenship? Birth Naturalization Parents
If you answered “No,” provide your spouse’s current U.S. immigration status:
24. How many times has your current spouse been married (including your current marriage, if applicable)?
Your Spouse’s Contact Information
25. Does your current spouse reside with you? Yes/No
If you answered “No”, provide your current spouse’s physical address in Item Number 26.
26. Your Current Spouse's
Physical Address (if applicable)
27. Your Spouse’s Daytime Telephone Number 28. Your Spouse’s Mobile Telephone Number (if any) 29. Your Spouse’s Email Address (if any)
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Part 2. Information About Your Current Spouse
NOTE: If you are not currently married, skip to Part 3.
1. Date of Current Marriage (mm/dd/yyyy)
2.
Place Where Current Marriage Occurred 3. Name of Your Current Spouse Family Name (Last Name)
4. Other Names Your Current Spouse Has Used
Provide all other names your spouse has ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 13. Additional Information.
Family Name (Last Name) [deleted]
Spouse’s Date of Birth
(mm/dd/yyyy) Spouse’s USCIS Online Account Number
Spouse’s City/Town/Village of
Birth
Is your spouse a U.S. citizen? Yes/No
If you answered “Yes,” how did your spouse obtain U.S. citizenship? Birth Naturalization Parents
If you answered “No,” provide your spouse’s current U.S. immigration status:
5. How many times has your current spouse been married (including your current marriage)?
[Page 5]
Your Spouse’s Contact Information
6. Does your current spouse reside with you? Yes/No
If you answered “No,” provide your current spouse’s physical address in Item Number 7.
7. Your Current Spouse's Physical Address
8. Your Spouse’s Daytime Telephone Number 9. Your Spouse’s Mobile Telephone Number
10. Your Spouse’s Email Address
Your Spouse’s Duty of Disclosure
Your spouse must answer the following questions. See the Duty of Disclosure section in the Form I-600 Instructions concerning your spouse’s ongoing duty to disclose information in response to these questions. If your spouse answers "Yes" to any of these questions, provide a certified copy of the documentation showing the final disposition of each incident which resulted in arrest, indictment, conviction, and/or any other judicial or administrative action and a written statement giving details, including any mitigating circumstances about each arrest, signed by your spouse under penalty of perjury under U.S. law. The written statement must show the date of each incident; place each incident occurred (city/town, state/province, country); name of police department or other law enforcement administration or other entity involved; and date of incarceration and name of facility. Provide a description of any type of counseling, rehabilitation, or other information that your spouse would like considered in light of this history.
11.
Has your spouse EVER,
whether in or outside the United States: A.
Been investigated, arrested, cited, charged, indicted, convicted,
fined, or imprisoned for breaking or violating any law or
ordinance? (Answer “Yes,” even if the record of the
arrest, conviction, or other criminal history was expunged,
sealed, pardoned, or the subject of any other amelioration. Do
not include parking or traffic violations, except for violations
for driving or operating a vehicle while intoxicated, or while
impaired by, or under the influence of, alcohol or another
intoxicant.) Yes No B. Received a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action? Yes No
C.
Received a suspended sentence, been placed on probation or parole,
or been in an alternative sentencing or rehabilitation program,
such as diversion, deferred prosecution, deferred or withheld
adjudication, or expungement of a criminal charge? Yes No D. Yes No
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Page 6, Part 2. Information About the Orphan Beneficiary |
Part 2. Information About Orphan Beneficiary |
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Page 10, Part 3. Information About Your Home Study and Primary Adoption Service Provider |
Part 3. Information About Your Home Study and Primary Adoption Service Provider |
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Page 4, Part 1. Information About You (Petitioner) |
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Additional Household Members
30. How many persons 18 years of age or older (other than your spouse, if married) reside with you?
If you answered "1" or more, you MUST complete Form I-600A/I-600 Supplement 1, Listing of Adult Member of the Household, for each person.
31. List all of your children who are under 18 years of age. Also include any other children under 18 years of age who reside in your household, regardless of your relationship to those children. If you need extra space to complete this table, use the space provided in Part 10. Additional Information.
[Table 5 entries] Name (First/Middle/Last) Date of Birth (mm/dd/yyyy) Country of Birth A-Number (if any) Relationship to You
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[Page 6]
Part 3. Information About Additional Household Members
1. How many persons 18 years of age or older (other than your spouse, if married), reside with you?
If you answered one or more, you MUST complete Form I-600A/I-600 Supplement 1, Listing of Adult Member of the Household, for each person.
2. List all of your children who are under 18 years of age. Also include any other children under 18 years of age who reside in your household, regardless of your relationship to those children. If you need extra space to complete this table, use the space provided in Part 13. Additional Information.
[Table 5 entries] Name (First/Middle/Last) Date of Birth (mm/dd/yyyy) Country of Birth A-Number Relationship to You
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Page 11, Part 4. Information About Fes, Expenses, and Other Compensation |
Part 4. Information About Fes, Expenses, and Other Compensation |
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Page 12, Part 5. Accommodations for Individuals With Disabilities and/or Impairments |
Part 5. Accommodations for Individuals With Disabilities and/or Impairments |
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Page 5, Part 1. Information About You (Petitioner) |
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Information About Prior Filings or Adoptions
If you need extra space to complete Item Numbers 32. - 37., use the space provided in Part 10. Additional Information.
32. Have you ever previously filed Form I-600, Form I-600A, Application for Advance Processing of an Orphan Petition, Form I-800A, Application for Determination of Suitability to Adopt a Child From a Convention Country, Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative, or Form I-130, Petition for Alien Relative, for an adopted child? Yes/No
If you answered “Yes,”
provide the following information for EACH petition and/or
application: Type of Petition/Application Filed: Form I-600A Form I-600 Form I-800A Form I-800 Form I-130 (for an adopted child)
Result: Approved Denied Withdrawn Revoked Other (please explain): [fillable field] Date (mm/dd/yyyy)
33. Have you previously completed a domestic adoption of a child within the U.S.? Yes/No
If you answered “Yes,” provide the following information for each completed domestic adoption of a child.
State And County Where Adoption Was Finalized
Date Adoption Was Finalized (mm/dd/yyyy)
34. Have you ever previously attempted to adopt a child internationally or domestically, but the adoption was disrupted before it was finalized? An adoption is disrupted if you (or a custodian escorting the child on your behalf) are granted legal custody or guardianship of the child, but the adoptive placement is interrupted before the adoption was finalized. Yes No
If you answered “Yes,” provide a detailed description of the disruption. [Fillable field]
35. Have you ever previously completed an adoption, either in the United States or abroad, that was later dissolved? An adoption is dissolved if your parental rights over the adopted child are terminated at any time after the adoption was finalized. Yes No
If you answered “Yes,” provide a detailed description of the dissolution. [Fillable field]
36. Have you ever previously placed a child in the care of another person with the intent to transfer permanent custody of the child? Yes No
If you answered “Yes,” provide a detailed description of the placement. [Fillable field]
37. Have you ever received a child with the intent to gain permanent custody, but without involving the child welfare or other state/local authorities or following the state/local process? Yes No
If you answered “Yes,” provide a detailed description of the custody transfer. [Fillable field]
[Page 6]
Duty of Disclosure
You and your spouse (if married) must answer the following questions. See the Duty of Disclosure section in the Form I-600 Instructions concerning your ongoing duty to disclose information in response to these questions. If you or your spouse answer "Yes" to any of the questions in Item Numbers 38. and 39., provide a certified copy of the documentation showing the final disposition of each incident which resulted in arrest, indictment, conviction, and/or any other judicial or administrative action and a written statement giving details, including any mitigating circumstances about each arrest, signed by you and/or your spouse (if married) under penalty of perjury under U.S. law. The written statement must show the date of each incident; place incident occurred (city/town, state/province, country); name of police department or other law enforcement administration or other entity involved; date of incarceration and name of facility, if applicable. Provide a description of any type of counseling, rehabilitation, or other information that you and your spouse (if married) would like considered in light of this history in the space provided in Part 10. Additional Information.
38. Have you EVER,
whether in or outside the United States: A. Been investigated, arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance? (Answer “Yes,” even if the record of the arrest, conviction, or other adverse criminal history was expunged, sealed, pardoned, or the subject of any other amelioration. Do not include traffic violations, except for violations for driving or operating a vehicle while intoxicated or while impaired by or under the influence of alcohol or other intoxicant.) Yes No
B. Received a pardon,
amnesty, rehabilitation decree, other act of clemency, or similar
action? Yes No C. Received a suspended sentence, been placed on probation or parole, or been in an alternative sentencing or rehabilitation program, such as diversion, deferred prosecution, deferred or withheld adjudication, or expungement of a criminal charge? Yes No
D. Been the subject of any
investigation at any time even if closed or unsubstantiated, by
any child welfare agency, court, or other official authority in
any state or foreign country concerning the abuse or neglect of
any child? Yes No 39. Has your spouse EVER,
whether in or outside the United States: A. Been investigated,
arrested, cited, charged, indicted, convicted, fined, or
imprisoned for breaking or violating any law or ordinance?
(Answer “Yes,” even if the record of the arrest,
conviction, or other adverse criminal history was expunged,
sealed, pardoned, or the subject of any other amelioration. Do
not include traffic violations, except for violations for driving
or operating a vehicle while intoxicated or while impaired by or
under the influence of alcohol or other intoxicant.) Yes No B. Received a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action? Yes No
C. Received a suspended
sentence, been placed on probation or parole, or been in an
alternative sentencing or rehabilitation program, such as
diversion, deferred prosecution, deferred or withheld
adjudication, or expungement of a criminal charge? Yes No D. Been the subject of any investigation at any time even if closed or unsubstantiated, by any child welfare agency, court, or other official authority in any state or foreign country concerning the abuse or neglect of any child? Yes No
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[Page 6]
Part 4. Information About Prior Filings or Adoptions
If you need extra space to complete Item Numbers 1. - 6., use the space provided in Part 13. Additional Information.
1. Have you ever previously filed Form I-600; Form I-600A, Application for Advance Processing of an Orphan Petition; Form I-800A, Application for Determination of Suitability to Adopt a Child From a Convention Country; Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative; or Form I-130, Petition for Alien Relative for an adopted child? Yes/No
If you answered “Yes,”
provide the following information for EACH petition and/or
application: [No change]
2. Have you previously completed a domestic adoption of a child within the U.S.? Yes No
If you answered “Yes,” provide the following information for each completed domestic adoption.
State And County Where Adoption Was Finalized
Date Adoption Was Finalized (mm/dd/yyyy)
[Page 7]
3. Have you ever previously attempted to adopt a child internationally or domestically, but the adoption was disrupted before it was finalized? An adoption is disrupted if you (or a custodian escorting the child on your behalf) are granted legal custody or guardianship of the child, but the adoptive placement is interrupted before the adoption was finalized. Yes No
If you answered “Yes,” provide a detailed description of the disruption. [Fillable field]
4. Have you ever previously completed an adoption, either in the United States or abroad, that was later dissolved? An adoption is dissolved if your parental rights over the adopted child are terminated at any time after the adoption was finalized. Yes No
If you answered “Yes,” please provide a detailed description of the dissolution. [Fillable field]
5. Have you ever previously placed a child in the care of another person with the intent to transfer permanent custody of the child? Yes No
If you answered “Yes,” please provide a detailed description of the placement. [Fillable field]
6. Have you ever received a child with the intent to gain permanent custody but without involving child welfare or other state/local authorities or following a state/local process? Yes No
If you answered “Yes,” please provide a detailed description of the custody transfer. [Fillable field]
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Page 6, Part 2. Information About the Orphan Beneficiary |
[Page 6]
Part 2. Information About the Orphan Beneficiary
1. Name at Birth Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
2. Current Name Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
3. Other Names the Orphan Has Used
Provide all other names the orphan has ever used, including aliases and nicknames. If you need extra space to complete this section, use the space provided in Part 10. Additional Information.
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
4. Gender Male/Female
5. Date of Birth (mm/dd/yyyy)
6. City/Town/Village of Birth
7. State or Province of Birth
8. Country of Birth
9. The beneficiary is an orphan because (Select only one box):
A. He or she has no parents due to the death or disappearance of, abandonment or desertion by, or separation or loss from both parents.
B. He or she has a sole or surviving parent who is incapable of providing proper care and who has in writing irrevocably released the child for emigration and adoption.
[Page 6]
10. If the orphan has a sole or surviving parent, answer the following:
A. What happened to the other birth or previous parent? [Fillable field]
B. Is the remaining parent capable of providing proper care for the orphan? Y/N
C. Has the remaining parent irrevocably released the orphan for emigration and adoption, in writing? Y/N
11. Did you adopt the orphan abroad? Yes/No
12. Did your spouse (if married) adopt the child abroad? Yes/No
13. If you answered "Yes" to Item Number 11. or Item Number 12., provide the following information:
A. Did you or your spouse (if married) personally see and observe the child before or during the adoption proceedings (this does not include the visa interview and issuance)? Yes/No
B. Date of Adoption (mm/dd/yyyy)
C. Place of Adoption
14. If you answered "No" to either Item Number 11., Item Number 12., or Item A. in Item Number 13., provide the following information:
NOTE: If you need extra space to complete Items A. - D., use the space provided in Part 10. Additional Information.
A. Do you and your spouse (if married) intend to adopt the orphan in the United States? Y/N
B. Provide a written description of all the pre-adoption requirements of the state of the orphan’s proposed residence and cite any relevant state statutes and regulations. If the state of the orphan’s proposed residence does not have any pre-adoption requirements, indicate “not applicable.” [Fillable field]
[Page 8]
C. Have any pre-adoption requirements of the orphan's proposed state of residence already been met? Yes/No
If you answered “Yes,” provide which requirements have been met. [Fillable field]
D. Will any pre-adoption requirements be met at a later time? Yes/No
If you answered “Yes,” describe the steps you will take to comply with these requirements. [Fillable field]
If you answered “No,” provide each pre-adoption requirement that will not be met and explain why. [Fillable field]
15. To your knowledge: A. Does the orphan have any special need, disability, and/or impairment? Yes/No
B. If you answered "Yes," name or describe the special need, disability, and/or impairment. [Fillable field]
16. The orphan’s legal custodian is (select only one box): [] An individual or entity other than the orphan’s birth parents. Name of the individual or entity: [Fillable field] [] Both of the orphan’s living birth parents. [] One of the orphan’s living birth parents. The living birth parent is the (select only one box): Mother/Father
17. Information About the Attorney Abroad Representing You and/or Your Spouse (if married) in this Case (if any)
[Page 9]
18. Address Where the Orphan Will Reside After the Adoption (or after you obtain legal custody)
Street Number and Name Province Postal Code Country
19. Current Address of the Orphan In Care Of Name
20. If the orphan resides in
an institution, provide the full name of the institution. 21. If the orphan does not reside in an institution, provide the full name of the person with whom the orphan is residing or the name of the orphan's caretaker.
22. Provide any additional information necessary to locate the orphan, such as the name of a district, section, zone, or locality in which the orphan resides: [Fillable field]
23. After you obtain an adoption or legal custody of the orphan, do you intend to:
A. Seek an immigrant visa because the child will reside with you in the United States? Y/N
B. Seek a non-immigrant visa for the child to travel to the United States temporarily for the purpose of naturalization, because you will continue to reside abroad with the child immediately following the adoption? Y/N
The U.S. Embassy or U.S. Consulate located at: [Fillable field]
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[Page 7]
Part 5. Information About The Orphan Beneficiary
1. Name at Birth 2. Current Name
3. Other Names the Child Has Used
Provide all other names the child has ever used, including aliases and nicknames. If you need extra space to complete this section, use the space provided in Part 13. Additional Information.
Family Name (Last Name) Given Name (First Name) Middle Name
[No change]
[Page 8]
9. The child beneficiary is an orphan because (Select only one box):
[No change]
10. If the child
has a sole or surviving parent, answer the following: A. What happened to the other birth or previous parent? [Fillable field] B. Is the remaining parent
capable of providing proper care for the child?
Yes/No C. Has the remaining parent irrevocably released the child for emigration and adoption, in writing? Yes/No
11. Did you adopt the child abroad? Yes/No
12. Did your spouse (if married) adopt the child abroad? Yes/No
13. If you answered “Yes” to Item Number 11. or Item Number 12., provide the following information:
A. Did you or your spouse (if married) personally see and observe the child before or during the adoption proceedings? (This does not include the visa interview and issuance.) Yes/No
B. Date of Adoption
(mm/dd/yyyy) C. Place of Adoption
14. If you answered "No" to either Item Number 11., Item Number 12., or Item A. in Item Number 13., provide the following information:
NOTE: If you need extra space to complete Items A. - D., use the space provided in Part 13. Additional Information.
A. Do you and your spouse (if
married) intend to adopt the child in
the United States? Yes/No B. Provide a written description of all the pre-adoption requirements of the state of the child’s proposed residence and cite any relevant state statutes and regulations. If the state of the child’s proposed residence does not have any pre-adoption requirements, indicate “not applicable.” [Fillable field]
C. Have any pre-adoption requirements of the child's proposed state of residence already been met? Yes/No
If you answered “Yes,” provide which requirements have been met. [Fillable field]
D. Will any pre-adoption requirements be met at a later time? Yes/No
[Page 9]
If you answered “Yes,” describe the steps you will take to comply with these requirements. [Fillable field]
If you answered “No,” provide each pre-adoption requirement that will not be met and explain why. [Fillable field]
15. To your knowledge: A. Does the child have any special need, disability, and/or impairment? Yes/No
B. If you answered "Yes," name or describe the special need, disability, and/or impairment. [Fillable field]
16. The child’s legal custodian is (select only one box): [] An individual or entity other than the child’s birth parents. Name of the individual or entity: [Fillable field] [] Both of the child’s living birth parents. [] One of the child’s living birth parents. The living birth parent is the (select one): Mother/Father
17. Information About the Attorney Abroad Representing You and/or Your Spouse (if married) in this Case
[Page 9]
18. Address Where the Child Will Reside After the Adoption (or after you obtain legal custody)
Street Number and Name Number Province Postal Code Country
[Page 10]
19. Current Address of the Child In Care Of Name Number
20. If the child
resides in an institution, provide the full name of the
institution. 21. If the child does not reside in an institution, provide the full name of the person with whom the child is residing or the name of the child's caretaker.
22. Provide any additional information necessary to locate the child, such as the name of a district, section, zone, or locality in which the child resides: [Fillable field]
23. After you obtain an adoption or legal custody of the child, do you intend to:
[No change]
24. Where do you wish to file your visa application?
The U.S. Embassy or U.S. Consulate located at: [Fillable field]
|
Page 10, Part 3. Information About Your Home Study and Primary Adoption Service Provider |
[Page 10]
Part 3. Information About Your Home Study and Primary Adoption Service Provider
1. Your home study:
A. Was previously submitted
with your approved Form I-600A application (please attach a
copy of your Form I-600A approval notice). B. Was previously submitted with your pending Form I-600A application (please attach a copy of your Form I-600A fee receipt notice).
C. IS attached to this Form I-600.
D. IS NOT attached
to this Form I-600 because of state requirements necessitating
review and documentation. The appropriate state authority has
indicated that it will submit the home study directly to U.S.
Citizenship and Immigration Services (USCIS). (Do not submit your
Form I-600 to USCIS until the state authority is ready to send
your home study to USCIS.)
Information About Your Primary Adoption Service Provider
NOTE: A primary adoption service provider is the accredited agency or approved person who is responsible under 22 CFR 96 for ensuring all six adoption services defined in 22 CFR 96.2 are provided according to the law, for supervising and being responsible for supervised providers when used (see 22 CFR 96.14), and for developing and implementing a service plan in accordance with 22 CFR 96.44.
2. Name of Primary Adoption
Service Provider 3. Point of Contact Within
the Organization 4. Primary Adoption Service
Provider's Mailing Address
6. Primary Adoption Service
Provider's Fax Number (if any) 7. Primary Adoption Service
Provider's Email Address (if any) 8. The primary adoption
service provider named above is one of the following: A. An accredited agency in
the United States. Yes/No B. An approved person in the United States. Yes/No
|
[Page 10]
Part 6. Information About Your Home Study and Primary Adoption Service Provider
1. Your home study:
A. Was previously submitted
with your approved and valid
Form I-600A application (please attach a copy of your Form
I-600A approval notice). B. Was previously submitted with your pending Form I-600A application (please attach a copy of your Form I-600A fee receipt notice).
C. Was previously submitted with a Form I-600A/I-600, Supplement 3 (please attach a copy of your Form I-600A/I-600, Supplement 3 fee receipt notice).
D. IS attached to this Form I-600.
E.
IS NOT attached to this Form I-600 because of
state requirements necessitating review and documentation. The
appropriate state authority has indicated that it will submit the
home study directly to USCIS. (Do
not submit your Form I-600 to USCIS until the state authority is
ready to send your home study to USCIS.) [Page 11]
Information About Your Primary Adoption Service Provider
A primary adoption service provider is the accredited agency or approved person who is responsible under 22 CFR 96 for ensuring all six adoption services defined in 22 CFR 96.2 are provided according to the law, for supervising and being responsible for supervised providers when used (see 22 CFR 96.14), and for developing and implementing a service plan in accordance with 22 CFR 96.44.
2. Name of Primary Adoption
Service Provider 3. Point of Contact Within
the Organization 4. Primary Adoption Service
Provider's Mailing Address
6. Primary Adoption Service
Provider's Fax Number 7. Primary Adoption Service
Provider's Email Address 8. The primary adoption
service provider named above is one of the following: A. An accredited agency in
the United States. Yes/No B. An approved person in the United States. Yes/No
|
Page 11, Part 4. Information About Fees, Expenses, and Other Compensation |
[Page 11]
Part 4. Information About Fees, Expenses, and Other Compensation
If you need extra space to complete the tables in Item Numbers 1. or 2., use the space provided in Part 10. Additional Information.
1. Information on payments already made. In the following table, provide all payments, including in-kind contributions that you and your spouse (if married) have made in relation to the adoption of the child identified in this Form I-600. The information you provide in this table must include all fees, expenses, in-kind contributions, and other compensation that you and your spouse (if married) or anyone on behalf of you and your spouse, have directly or indirectly made, to any individual, agency, entity, governmental authority, or other payee or recipient. The information below should include all payments made as of the date of your signing this Form I-600.
[Table 4 entries] Date (mm/dd/yyyy) Payee Relationship to Child (if any) Purpose of Payment Amount of Payment (or description and value of in kind consideration)
2. Information on anticipated future payments. In the following table, provide all fees, expenses, in-kind contributions, and other compensation that you and your spouse (if married) or anyone on behalf of you and your spouse, reasonably expect to pay or make, either directly or indirectly, to any individual, agency, entity, governmental authority, or other payee or recipient.
[Table 4 entries] Anticipated Date of Payment (mm/dd/yyyy) Payee Relationship to Child (if any) Purpose of Payment Amount of Payment (or description and value of in kind consideration)
[Page 12]
3. Have you or your spouse (if married) or anyone on behalf of you and your spouse, given or arranged to give money or other consideration either directly or indirectly to the orphan’s parent(s), agent(s), other individual(s), or entity to induce or encourage the release of the orphan? Yes/No
If you answered “Yes,” provide a detailed description to explain. [Fillable Field]
|
[Page 12]
Part 7. Information About Fees, Expenses, and Other Compensation
If you need extra space to complete the tables in Item Numbers 1. or 2., use the space provided in Part 13. Additional Information.
1. Information on payments already made. In the following table, provide all payments, including in-kind contributions that you and your spouse (if married) have made in relation to the adoption of the child identified in this Form I-600. The information you provide in this table must include all fees, expenses, in-kind contributions, and other compensation that you and your spouse (if married) or anyone on behalf of you or your spouse (if married) have directly or indirectly made to any individual, agency, entity, governmental authority, or other payee or recipient. The information below should include all payments made as of the date of your signing this Form I-600.
[Table 4 entries] Date of Payment (mm/dd/yyyy) Payee Relationship to Child Purpose of Payment Amount of Payment (or description and value of in-kind consideration)
2. Information on anticipated future payments. In the following table, provide all fees, expenses, in-kind contributions, and other compensation that you and your spouse (if married) or anyone on behalf of you or your spouse (if married) reasonably expect to pay or make, either directly or indirectly, to any individual, agency, entity, governmental authority, or other payee or recipient.
[Table 4 entries] Anticipated Date of Payment (mm/dd/yyyy) Payee Relationship to Child Purpose of Payment Amount of Payment (or description and value of in kind consideration)
[Page 13]
3. Have you or your spouse (if married) or anyone on behalf of you or your spouse (if married) given or arranged to give money or other consideration either directly or indirectly to the child’s parent(s), agent(s), other individual(s), or entity to induce or encourage the release of the child? Yes/No
If you answered “Yes,” provide a detailed description to explain. [Fillable Field]
|
Page 12, Part 5. Accommodations for Individuals With Disabilities and/or Impairments |
[Page 12]
Part 5. Accommodations for Individuals With Disabilities and/or Impairments
NOTE: Read the information in the Form I-600 Instructions before completing this section.
1. Are you requesting an accommodation because of your disabilities and/or impairments? Yes/No
2. If you answered “Yes,” select all applicable boxes below to indicate who has the disabilities and/or impairments. Petitioner Spouse Other Adult Household Member
3. If you answered “Yes” to Item Number 1., select all applicable boxes in Items A. - C. and provide an answer for each person with disabilities and/or impairments.
A. Deaf or hard of hearing and request the following accommodation. (If requesting a sign-language interpreter, indicate for which language (for example, American Sign Language).): [Fillable field]
B. Blind or have low vision and request the following accommodation: [Fillable field]
C. Another type of disability and/or impairment. (Describe the nature of the disability and/or impairment and the requested accommodation.): [Fillable field]
|
[Page 13]
Part 8. Accommodations for Individuals With Disabilities and/or Impairments
[No change]
2. If you answered “Yes,” select all applicable boxes below to indicate who has the disabilities and/or impairments. Petitioner Spouse Adult Member of the Household
|
Page 12, Part 6. Petitioner’s Statement, Certification, Duty of Disclosure, and Signature |
[Page 12]
Part 6. Petitioner’s Statement, Certification, Duty of Disclosure, and Signature
NOTE: Read the Penalties section of the Form I-600 Instructions before completing this section.
Petitioner’s Statement
1. Petitioner’s Statement Regarding the Interpreter (Select the box for either Item A. or B.)
A. I can read and understand English, and I have read and understand every question and instruction on this petition and my answer to every question.
B. The interpreter named in Part 8. read to me every question and instruction on this petition and my answer to every question in [Fillable field], a language in which I am fluent, and I understood everything.
2. Petitioner’s Statement Regarding the Preparer (if applicable)
At my request, the preparer named in Part 9., [Fillable field], prepared this petition for me based only upon information I provided or authorized.
[Page 13]
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 suitability and eligibility as an adoptive parent and whether the child I am petitioning for is eligible to be classified as my immediate relative.
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 law.
I understand that USCIS will require me to appear for an appointment to take my biometrics (for example, fingerprints, photograph, and/or signature) and, at that time, I will be required to sign an oath reaffirming that:
1) I reviewed and provided or authorized all of the information in my petition;
2) I understood all of the information contained in, and submitted with, my petition; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my petition, I understand all of the information contained in and submitted with my petition, and that all of this information is complete, true, and correct.
Petitioner’s Duty of Disclosure
I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as described in the Form I-600 and/or Form I-600A Instructions, and I agree to notify my home study preparer and USCIS of any new information that I am required to disclose.
Petitioner’s Signature
3. Petitioner’s
Signature
NOTE TO ALL PETITIONERS: If you do not completely fill out this petition or fail to submit required documents listed in the Instructions, USCIS may deny your petition.
|
[Page 13]
Part 9. Petitioner’s Statement, Certification, Duty of Disclosure, and Signature
[No change]
1. Petitioner’s Statement Regarding the Interpreter (select the box for either Item A. or B.)
A. I can read and understand English, and I have read and understand every question and instruction on this petition and my answer to every question.
B. The interpreter named in Part 11. read to me every question and instruction on this petition and my answer to every question in [Fillable field], a language in which I am fluent, and I understood everything.
2. Petitioner’s Statement Regarding the Preparer (if applicable)
At my request, the preparer named in Part 12. prepared this petition for me based only upon information I provided or authorized.
[Page 14]
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 suitability and eligibility to adopt and whether the child I am petitioning for is an orphan and eligible to be classified as my immediate relative.
[No change]
I certify, under penalty of perjury under the laws of the United States, that I provided or authorized all of the information in my petition, I understand all of the information contained in and submitted with my petition, and that all of this information is complete, true, and correct.
Petitioner’s Duty of Disclosure
I understand the ongoing duty to disclose information concerning my suitability and eligibility to adopt, as described in the Form I-600 and/or Form I-600A Instructions, and I agree to notify my home study preparer and USCIS of any new information that I am required to disclose.
[No change] |
Page 13, Part 7. Your Spouse’s Statement, Certification, Duty of Disclosure, and Signature |
[Page 13]
Part 7. Your Spouse’s Statement, Certification, Duty of Disclosure, and Signature
NOTE: Read the Penalties section of the Form I-600 Instructions before completing this section.
Your Spouse’s Statement
1. Spouse’s Statement Regarding the Interpreter (Select the box for either Item A. or B.)
A. I can read and understand English, and have read and understand every question and instruction on this petition and my answer to every question.
B. The interpreter named in Part 8. read to me every question and instruction on this petition and my answer to every question in [Fillable field], a language in which I am fluent, and I understood everything.
2. Spouse’s Statement Regarding the Preparer (if applicable)
At my request, the preparer named in Part 9., [Fillable field], prepared this petition for me based only upon information I provided or authorized.
[Page 14]
Your Spouse’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 suitability and eligibility as an adoptive parent and whether the child my spouse is petitioning for is eligible to be classified as our immediate relative.
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 law.
I understand that USCIS will require me to appear for an appointment to take my biometrics (for example, fingerprints, photograph, and/or signature) and, at that time, I will be required to sign an oath reaffirming that:
1) I reviewed and provided or authorized all of the information in my petition;
2) I understood all of the information contained in, and submitted with, my petition; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my petition, I understand all of the information contained in and submitted with my petition, and that all of this information is complete, true, and correct.
Your Spouse’s Duty of Disclosure
I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as described in the Form I-600 and/or Form I-600A Instructions, and I agree to notify the home study preparer and USCIS of any new information that I am required to disclose.
Your Spouse’s Signature
3. Your Spouse’s Signature |
[Page 14]
Part 10. Your Spouse’s Statement, Certification, Duty of Disclosure, and Signature
NOTE: Read the Penalties section of the Form I-600 Instructions before completing this section.
Your Spouse’s Statement
1. Spouse’s Statement Regarding the Interpreter (select the box for either Item A. or B.)
A. I can read and understand English, and have read and understand every question and instruction on this petition and my answer to every question.
B. The interpreter named in Part 11. read to me every question and instruction on this petition and my answer to every question in [Fillable field], a language in which I am fluent, and I understood everything.
2. Spouse’s Statement Regarding the Preparer (if applicable)
At my request, the preparer named in Part 12., prepared this petition for me based only upon information I provided or authorized.
[Page 15]
Your Spouse’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 suitability and eligibility to adopt and whether the child my spouse is petitioning for is an orphan and eligible to be classified as our immediate relative.
[No change]
I certify, under penalty of perjury under the laws of the United States, that I provided or authorized all of the information in my petition, I understand all of the information contained in and submitted with my petition, and that all of this information is complete, true, and correct.
Your Spouse’s Duty of Disclosure
I understand the ongoing duty to disclose information concerning my suitability and eligibility to adopt, as described in the Form I-600 and/or Form I-600A Instructions, and I agree to notify the home study preparer and USCIS of any new information that I am required to disclose.
Your Spouse’s Signature
3. Your Spouse’s Signature |
Page 14, Part 8. Interpreter’s Contact Information, Certification, and Signature |
[Page 14]
Part 8. Interpreter’s Contact Information, Certification, and Signature
If you and/or your spouse (if married) used an interpreter to read and complete this petition, provide the following information about the interpreter.
Interpreter’s Full Name 1. Interpreter's Family Name (Last Name) Interpreter's Given Name (First Name)
[Page 15]
Interpreter’s Mailing
Address 3. Street Number and Name Apt. Ste. Flr. City or Town
Interpreter’s Contact
Information 4. Interpreter's Daytime Telephone Number 5. Interpreter’s
Mobile Telephone Number (if any)
I certify, under penalty of perjury, that:
I am fluent in English and [Fillable field], which is the same language specified in Parts 6. and 7., Item B in Item Number 1., and I have read to this petitioner and/or the petitioner’s spouse in the identified language every question and instruction on this petition and their answer to every question. The petitioner and/or the petitioner’s spouse informed me that he or she understands every instruction, question, and answer on the petition, including the Petitioner’s Certification and the Your Spouse’s Certification, and has verified the accuracy of every answer.
Interpreter’s Signature 7. Interpreter's Signature Date of Signature (mm/dd/yyyy) |
[Page 15]
Part 11. Interpreter’s Contact Information, Certification, and Signature
[No change]
[Page 16]
I certify, under penalty of perjury under the laws of the United States, that:
I am fluent in English and [Fillable field], which is the same language specified in Parts 9. and 10., Item B. in Item Number 1., and I have read to this petitioner and/or the petitioner’s spouse in the identified language every question and instruction on this petition and his or her answer to every question. The petitioner and/or the petitioner’s spouse informed me that he or she understands every instruction, question, and answer on the petition, including the Petitioner’s Certification and the Your Spouse’s Certification, and has verified the accuracy of every answer.
Interpreter’s Signature 7. Interpreter's Signature Date of Signature (mm/dd/yyyy) |
Page 15, Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Petition, If Other Than the Petitioner and Spouse |
[Page 15]
Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Petition, If Other Than the Petitioner and Spouse
If you and/or your spouse (if married) used a preparer to complete this petition, provide the following information about the preparer.
Preparer’s Full
Name 1. Preparer’s
Family Name (Last Name)
[Page 16]
Preparer’s Mailing Address
3. Street Number and
Name City or Town
Preparer’s Contact Information
4. Preparer’s
Daytime Telephone Number
Preparer’s
Statement 7. A. I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and/or the petitioner’s spouse (if married) with the petitioner’s and/or the petitioner’s spouse’s consent.
B. I am an attorney or accredited representative and my representation of the petitioner and/or the petitioner’s spouse (if married) in this case extends/does not extend beyond the preparation of this petition.
Preparer’s
Certification By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner and/or the petitioner’s spouse (if married). The petitioner and the petitioner’s spouse (if married) then reviewed this completed petition and informed me that he or she understands all of the information contained in, and submitted with, his or her petition, including the Petitioner’s Certification and the Your Spouse’s Certification, and that all of this information is complete, true, and correct. I completed this petition based only on information that the petitioner provided to me or authorized me to obtain or use.
Preparer’s Signature
8. Preparer's Signature |
[Page 16]
Part 12. Contact Information, Declaration, and Signature of the Person Preparing this Petition, If Other Than the Petitioner and Spouse
[No change]
[Page 17]
Preparer’s
Statement 7. A. I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and/or the petitioner’s spouse with the petitioner’s and/or the petitioner’s spouse’s consent.
B. I am an attorney or accredited representative and my representation of the petitioner and/or the petitioner’s spouse in this case extends/does not extend beyond the preparation of this petition.
Preparer’s
Certification By my signature, I certify, under penalty of perjury under the laws of the United States, that I prepared this petition at the request of the petitioner and/or the petitioner’s spouse. The petitioner and/or the petitioner’s spouse then reviewed this completed petition and informed me that he or she understands all of the information contained in, and submitted with, his or her petition, including the Petitioner’s Certification and the Your Spouse’s Certification, and that all of this information is complete, true, and correct. I completed this petition based only upon information that the petitioner and/or the petitioner’s spouse provided to me or authorized me to obtain or use.
Preparer’s Signature
8. Preparer's Signature |
Page 17, Part 10. Additional Information |
[Page 17]
Part 10. 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. If you attach a separate sheet of paper, type or print your full 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.
1. Family Name (Last Name) [Auto-populated field] Given Name (First Name) [Auto-populated field] Middle Name [Auto-populated field]
2. A-Number (if any) [Auto-populated field]
3. A. Page Number B. Part Number C. Item Number D. [Fillable field]
4. A. Page Number B. Part Number C. Item Number D. [Fillable field]
5. A. Page Number B. Part Number C. Item Number D. [Fillable field]
6. A. Page Number B. Part Number C. Item Number D. [Fillable field]
|
[Page 18]
Part 13. 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. If you attach a separate sheet of paper, type or print your full name and A-Number 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.
1. Family Name (Last Name) [Auto-populated field] Given Name (First Name) [Auto-populated field] Middle Name [Auto-populated field]
2. A-Number [Auto-populated field]
|
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ketchum, Joshua A |
| File Modified | 0000-00-00 |
| File Created | 2021-01-13 |