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

Petition to
Classify Orphan as an Immediate Relative

USCIS
Form I-600

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

OMB No. 1615-0028
Expires 12/31/2021

For U.S. Government Use Only
Receipt/Fee Stamp

Action Block

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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):

Department of State Actions:

Final Adjudicating Office/Post:

Approved

(Name of non-Hague Convention Country)

PAIR Letter Issued Date (if applicable)
(mm/dd/yyyy):

To be Completed By
an Attorney or
Accredited
Representative (if any)

Transfer to USCIS as Not Clearly
Approvable

Officer Signature and Date:

Transfer to USCIS as Consular Return

Child's Legal Name after Adoption:

Select this box if
Form G-28 or 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 in black ink. Complete a separate petition for each child. This petition is made to classify an
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.

Part 1. Information About You (Petitioner)
1.

Family Name (Last Name)

2.

Other Names Used (if any)

Given Name (First Name)

Middle Name (if applicable)

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 (if any)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Form I-600 Edition 12/21/19

ZIP Code

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Part 1. Information About You (Petitioner) (continued)
4.

Yes

Is your current U.S. mailing address the same as your U.S. physical address?

No

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.

6.

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U.S. Physical Address (if any)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

ZIP Code

Address Abroad (if any)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

7.

Daytime Telephone Number

9.

Email Address (if any)

Country

8. Mobile Telephone Number (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?

Birth

Parents

Naturalization

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)

Given Name (First Name)

Middle Name (if applicable)

Alien Registration Number (A-Number) (if any) Certificate of Citizenship Number
►

A-

Date of Issuance

Place of Issuance

(mm/dd/yyyy)

Form I-600 Edition 12/21/19

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Part 1. Information About You (Petitioner) (continued)
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)

Given Name (First Name)

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A-Number (if any)
► A-

Middle Name (if applicable)

Certificate of Naturalization Number

Date of Naturalization

Place of Naturalization

(mm/dd/yyyy)

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 30.

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 A-Number (if any)
► ASpouse's City/Town/Village of Birth

Spouse's USCIS Online Account Number (if any)
►

Spouse's State or Province of Birth

Spouse's Country of Birth

Form I-600 Edition 12/21/19

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Part 1. Information About You (Petitioner) (continued)
Is your spouse a U.S. citizen?

Yes

If you answered "Yes," how did your spouse obtain U.S. citizenship?

Birth

Naturalization

No

Parents

If you answered "No," provide your spouse's current U.S. immigration status:

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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?
If you answered "No," provide your current spouse's physical address in Item Number 26.

Yes

No

26. Your Current Spouse's Physical Address (if applicable)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

27. Spouse's Daytime Telephone Number

ZIP Code

Country

28. Spouse's Mobile Telephone Number

29. Spouse's Email Address (if any)

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.
Name (First/Middle/Last)

Form I-600 Edition 12/21/19

Date of Birth
(mm/dd/yyyy)

Country of Birth

A-Number (if any)

Relationship to You

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Part 1. Information About You (Petitioner) (continued)
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?

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Yes

No

Yes

No

If you answered "Yes," provide the following information for EACH petition and/or application:
Type of Petition/Application Filed:
Form I-600A
Result:

Form I-600

Approved

Form I-800A

Denied

Form I-130 (for an adopted child)

Withdrawn

Revoked

Other (please explain):

Date (mm/dd/yyyy)

33. Have you previously completed a domestic adoption of a child within the U.S.?

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

Yes

No

Yes

No

Yes

No

If you answered "Yes," provide a detailed description of the disruption.

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.
If you answered "Yes," provide a detailed description of the dissolution.

36. Have you ever previously placed a child in the care of another person with the intent to transfer permanent
custody of the child?
If you answered "Yes," provide a detailed description of the placement.

37. 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 the state/local process?
If you answered "Yes," provide a detailed description of the custody transfer.

Form I-600 Edition 12/21/19

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Part 1. Information About You (Petitioner) (continued)
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 Number 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.

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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

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:

Part 2. Information About the Orphan Beneficiary
1.

Name at Birth
Family Name (Last Name)

2.

Given Name (First Name)

Middle Name (if applicable)

Given Name (First Name)

Middle Name (if applicable)

Current Name
Family Name (Last Name)

Form I-600 Edition 12/21/19

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Part 2. Information About the Orphan Beneficiary (continued)
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)

4.

Gender
Male

Given Name (First Name)

Middle Name (if applicable)

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5. Date of Birth (mm/dd/yyyy)

6. City/Town/Village of Birth

Female

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.

10. If the orphan has a sole or surviving parent, answer the following:
A. What happened to the other birth or previous parent?

B. Is the remaining parent capable of providing proper care for the orphan?

Yes

No

C. Has the remaining parent irrevocably released the orphan for emigration and adoption, in writing?

Yes

No

11. Did you adopt the orphan abroad?

Yes

No

12. Did your spouse (if married) adopt the orphan abroad?

Yes

No

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.)
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?

Yes

No

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."

Form I-600 Edition 12/21/19

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Part 2. Information About the Orphan Beneficiary (continued)
C. Have any pre-adoption requirements of the orphan's proposed state of residence already been met?

Yes

No

Yes

No

Yes

No

If you answered "Yes," provide which requirements have been met.

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D. Will any pre-adoption requirements be met at a later time?

If you answered "Yes," describe the steps you will take to comply with these requirements.

If you answered "No," provide each pre-adoption requirement that will not be met and explain why.

15. To your knowledge:

A. Does the orphan have any special need, disability, and/or impairment?

B. If you answered "Yes," name or describe the special need, disability, and/or impairment.

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:
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)
Family Name (Last Name)

Given Name (First Name)

Middle Name (if applicable)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Form I-600 Edition 12/21/19

Postal Code

ZIP Code

Country

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Part 2. Information About the Orphan Beneficiary (continued)
18. Address Where the Orphan Will Reside After the Adoption (or after you obtain legal custody)
Street Number and Name

Apt. Ste. Flr. Number

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City or Town

Province

State

Postal Code

ZIP Code

Country

19. Current Address of the Orphan
In Care Of Name

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

ZIP Code

Country

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.
Family Name (Last Name)

Given Name (First Name)

Middle Name (if applicable)

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:

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?

Yes

No

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?

Yes

No

24. Where do you wish to file your visa application (if applicable)?
The U.S. Embassy or U.S. Consulate located at:

Form I-600 Edition 12/21/19

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Part 3. Information About Your Home Study and Primary Adoption Service Provider
1.

Your home study:
Was previously submitted with your approved Form I-600A application (please attach a copy of your Form I-600A
A.
approval notice).
B.

Was previously submitted with your pending Form I-600A application (please attach a copy of your Form I-600A
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 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 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.)

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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
Family Name (Last Name)

4.

Given Name (First Name)

Primary Adoption Service Provider's Mailing Address
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

6.

ZIP Code

Primary Adoption Service Provider's Fax Number (if any)

5.

Primary Adoption Service Provider's Daytime Telephone Number

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

Form I-600 Edition 12/21/19

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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.

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Date
(mm/dd/yyyy)

2.

Payee

Relationship to
Child (if any)

Purpose of Payment

Amount of Payment (or description
and value of in kind consideration)

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.
Anticipated Date
of Payment
(mm/dd/yyyy)

Form I-600 Edition 12/21/19

Payee

Relationship to
Child (if any)

Purpose of Payment

Amount of Payment
(or description and value of in
kind consideration)

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Part 4. Information About Fees, Expenses, and Other Compensation (continued)
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

Yes

No

If you answered "Yes," provide a detailed description to explain.

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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 disabilities and/or impairments?

2.

If you answered "Yes," select all applicable boxes below to indicate who has the disabilities and/or impairments.
Petitioner

3.

Spouse

Other Adult Household Member

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).):

B.

Blind or have low vision and request the following accommodation:

C.

Another type of disability and/or impairment. (Describe the nature of the disability and/or impairment and the requested
accommodation.):

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
, 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.,

,

prepared this application for me based only upon information I provided or authorized.

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Part 6. Petitioner's Statement, Certification, Duty of Disclosure, and Signature (continued)
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.

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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

Date of Signature (mm/dd/yyyy)

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.

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
, 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.,

,

prepared this petition for me based only upon information I provided or authorized.

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Part 7. Your Spouse's Statement, Certification, Duty of Disclosure, and Signature (continued)
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.

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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

Date of Signature (mm/dd/yyyy)

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)

2.

Interpreter's Business or Organization Name (if any)

Form I-600 Edition 12/21/19

Interpreter's Given Name (First Name)

Page 14 of 17

Part 8. Interpreter's Contact Information, Certification, and Signature (continued)
Interpreter's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

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City or Town

Province

State

Postal Code

ZIP Code

Country

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

6.

Interpreter's Email Address (if any)

5. Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification

I certify, under penalty of perjury, that:
I am fluent in English and

, 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)

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)

2.

Preparer's Business or Organization Name (if any)

Form I-600 Edition 12/21/19

Preparer's Given Name (First Name)

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Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Petition, If Other
Than the Petitioner and Spouse (continued)
Preparer's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

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NOT FOR
PRODUCTION
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Postal Code

ZIP Code

Country

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

6.

Preparer's Email Address (if any)

5. Preparer's Mobile Telephone Number (if any)

Preparer's Statement
7.

A.

I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and/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

Form I-600 Edition 12/21/19

Date of Signature (mm/dd/yyyy)

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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.

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1.

Family Name (Last Name)

2.

A-Number (if any) ► A-

3.

A. Page Number

D.

4.

A. Page Number

D.

5.

A. Page Number

Given Name (First Name)

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

Middle Name

D.

6.

A. Page Number

D.

Form I-600 Edition 12/21/19

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