Page 1 of 17Form I-600 Edition 12/21/19
Petition to
Classify Orphan as an Immediate Relative
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-600
OMB No. 1615-0028
Expires 12/31/2021
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.
Part 1. Information About You (Petitioner)
Family Name (Last Name)
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
Given Name (First Name) Middle Name (if applicable)
Other Names Used (if any)
1.
2.
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.
Married Unmarried
For U.S. Government Use Only
The petitioner is:
Action Block
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.
Receipt/Fee Stamp
Approved
Department of State Actions:
Transfer to USCIS as Not Clearly
Approvable
Transfer to USCIS as Consular Return
Form I-600A Approval
The petitioner is approved to adopt an
orphan from (if specified):
Approval Valid Until (mm/dd/yyyy):
PAIR Letter Issued Date (if applicable)
(mm/dd/yyyy):
(Name of non-Hague Convention Country)
Final Adjudicating Office/Post:
Officer Signature and Date:
Child's Legal Name after Adoption:
Your Contact Information
City or Town State ZIP Code
Street Number and Name Apt. Flr. NumberSte.
3. U.S. Mailing Address (if any)
In Care Of Name (if any)
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)
To be Completed By
an Attorney or
Accredited
Representative (if any)
Page 2 of 17Form I-600 Edition 12/21/19
Part 1. Information About You (Petitioner) (continued)
Is your current U.S. mailing address the same as your U.S. physical address?
If you answered "No," provide your U.S. physical address in Item Number 5. or your address abroad in Item Number 6., as
appropriate.
4. NoYes
Number
Address Abroad (if any)
Street Number and Name
City or Town State
Apt. Flr.Ste.
Postal CodeProvince Country
6.
Number
U.S. Physical Address (if any)
Street Number and Name
City or Town State ZIP Code
Apt. Flr.Ste.
5.
Daytime Telephone Number7.
Mobile Telephone Number (if any)8.
Email Address (if any)9.
Information About Your U.S. Citizenship
10. USCIS Online Account Number (if any)
11. Date of Birth (mm/dd/yyyy)
City/Town/Village of Birth 12. State or Province of Birth13.
Country of Birth14.
How did you obtain your U.S. citizenship?
A.
Your Name On the Certificate of Citizenship
If you answered "Yes," provide the following information about your Certificate of Citizenship:
If you obtained your citizenship through your parents, have you obtained a Certificate of Citizenship in
your own name?
15.
Birth Parents Naturalization
Yes No
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
Certificate of Citizenship Number
A-
Alien Registration Number (A-Number) (if any)
Place of IssuanceDate of Issuance
(mm/dd/yyyy)
Page 3 of 17Form I-600 Edition 12/21/19
Part 1. Information About You (Petitioner) (continued)
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
A-Number (if any)
A-
Date of Naturalization Place of Naturalization
Certificate of Naturalization Number
B.
Your Name On the Certificate of Naturalization
If you obtained your citizenship through naturalization, provide the following information about your Certificate of Naturalization:
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?
16.
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? DivorcedMarriedSingle WidowedSeparated
How many times have you been married (including your current marriage, if applicable)?18.
NOTE: If you are not currently married, skip to Item Number 30.
Information About Your Current Marriage
21.
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
Name of Your Current Spouse
Other Names Your Current Spouse Has Used (if any)
Given Name (First Name) Family Name (Last Name) Middle Name (if applicable)
Spouse's A-Number (if any)
A-
Spouse's Country of Birth
Spouse's State or Province of Birth
Spouse's Date of Birth (mm/dd/yyyy)
Spouse's City/Town/Village of Birth
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.
Spouse's USCIS Online Account Number (if any)
22.
(mm/dd/yyyy)
19. Date of Current Marriage (mm/dd/yyyy)
20. Place Where Current Marriage Occurred
Information About Your Current Spouse23.
Page 4 of 17Form I-600 Edition 12/21/19
Part 1. Information About You (Petitioner) (continued)
Does your current spouse reside with you? 25.
24. How many times has your current spouse been married (including your current marriage, if applicable)?
If you answered "No," provide your current spouse's physical address in Item Number 26.
Yes No
Your Current Spouse's Physical Address (if applicable)
NumberStreet Number and Name Apt. Flr.Ste.
State ZIP Code
Province
City or Town
Postal Code Country
26.
Spouse's Daytime Telephone Number
Spouse's Email Address (if any)
Spouse's Mobile Telephone Number27. 28.
29.
Your Spouse's Contact Information
Additional Household Members
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.
30.
Name (First/Middle/Last)
Date of Birth
(mm/dd/yyyy)
Country of Birth A-Number (if any) Relationship to You
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.
31.
If you answered "No," provide your spouse's current U.S. immigration status:
Is your spouse a U.S. citizen? Yes No
If you answered "Yes," how did your spouse obtain U.S. citizenship? Birth Naturalization Parents
Page 5 of 17Form I-600 Edition 12/21/19
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.
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?
32.
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-130 (for an adopted child)
Result: Approved Denied Withdrawn
Other (please explain):
Date (mm/dd/yyyy)
Revoked
Have you previously completed a domestic adoption of a child within the U.S.? 33. 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)
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.
34. Yes No
If you answered "Yes," provide a detailed description of the disruption.
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.
35. Yes No
If you answered "Yes," provide a detailed description of the dissolution.
Have you ever previously placed a child in the care of another person with the intent to transfer permanent
custody of the child?
36. Yes No
If you answered "Yes," provide a detailed description of the placement.
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?
37. Yes No
If you answered "Yes," provide a detailed description of the custody transfer.
Page 6 of 17Form I-600 Edition 12/21/19
Part 1. Information About You (Petitioner) (continued)
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.
Duty of Disclosure
Have you EVER, whether in or outside the United States:38.
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
Received a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action?B. NoYes
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
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?
D.
NoYes
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
Received a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action?B. NoYes
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
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?
D.
NoYes
Part 2. Information About the Orphan Beneficiary
Name at Birth
Given Name (First Name) Family Name (Last Name) Middle Name (if applicable)
1.
Current Name
Middle Name (if applicable)Family Name (Last Name) Given Name (First Name)
2.
Page 7 of 17Form I-600 Edition 12/21/19
Given Name (First Name) Family Name (Last Name) Middle Name (if applicable)
Other Names the Orphan Has Used 3.
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.
5. Date of Birth (mm/dd/yyyy)4. Gender
Male Female
City/Town/Village of Birth
6.
7. Country of Birth8.State or Province of Birth
The beneficiary is an orphan because (select only one box):
A.
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.
B.
He or she has no parents due to the death or disappearance of, abandonment or desertion by, or separation or loss from
both parents.
9.
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?
10.
Has the remaining parent irrevocably released the orphan for emigration and adoption, in writing?C. Yes No
NoYes
11. Did you adopt the orphan abroad? Yes No
12. Did your spouse (if married) adopt the orphan abroad? Yes No
Part 2. Information About the Orphan Beneficiary (continued)
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.)
A.
If you answered "Yes" to Item Number 11. or Item Number 12., provide the following information:13.
NoYes
B. C.Date of Adoption (mm/dd/yyyy) Place of Adoption
If you answered "No" to either Item Number 11., Item Number 12., or Item A. in Item Number 13., provide the following
information:
A. Do you and your spouse (if married) intend to adopt the orphan in the United States?
B.
14.
Yes No
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."
NOTE: If you need extra space to complete Items A. - D., use the space provided in Part 10. Additional Information.
Page 8 of 17Form I-600 Edition 12/21/19
Part 2. Information About the Orphan Beneficiary (continued)
C.
Will any pre-adoption requirements be met at a later time?D. NoYes
Have any pre-adoption requirements of the orphan's proposed state of residence already been met? NoYes
If you answered "Yes," provide which requirements have been met.
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.
B.
Does the orphan have any special need, disability, and/or impairment?
If you answered "Yes," name or describe the special need, disability, and/or impairment.
The orphan's legal custodian is (select only one box):16.
Yes No
An individual or entity other than the orphan's birth parents.
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
Name of the individual or entity:
Information About the Attorney Abroad Representing You and/or Your Spouse (if married) in this Case (if any)17.
Middle Name (if applicable)Family Name (Last Name)
Given Name (First Name)
Street Number and Name Apt. Flr.Ste. Number
Postal CodeProvince Country
City or Town State ZIP Code
Page 9 of 17Form I-600 Edition 12/21/19
Part 2. Information About the Orphan Beneficiary (continued)
19. Current Address of the Orphan
City or Town State ZIP Code
In Care Of Name
Street Number and Name
Apt. Flr. NumberSte.
Province Postal 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.
Middle Name (if applicable)Family Name (Last Name)
Given Name (First Name)
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:
22.
Where do you wish to file your visa application (if applicable)?
The U.S. Embassy or U.S. Consulate located at:
23.
Address Where the Orphan Will Reside After the Adoption (or after you obtain legal custody)
Ste. Flr.Apt. NumberStreet Number and Name
StateCity or Town ZIP Code
18.
Province Postal Code Country
24.
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
Page 10 of 17Form I-600 Edition 12/21/19
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.
Name of Primary Adoption Service Provider
Primary Adoption Service Provider's Mailing Address
Street Number and Name
City or Town State ZIP Code
Apt. Flr.Ste.
Number
Point of Contact Within the Organization
Family Name (Last Name) Given Name (First Name)
Primary Adoption Service Provider's Daytime Telephone Number
Primary Adoption Service Provider's Fax Number (if any)
Primary Adoption Service Provider's Email Address (if any)
B. An approved person in the United States.
NoYes
The primary adoption service provider named above is one of the following:
A.
8.
An accredited agency in the United States. Yes No
2.
3.
4.
5. 6.
7.
Information About Your Primary Adoption Service Provider
Part 3. Information About Your Home Study and Primary Adoption Service Provider
Your home study:1.
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.)
B.
IS attached to this Form I-600.
C.
Was previously submitted with your pending Form I-600A application (please attach a copy of your Form I-600A fee
receipt notice).
Was previously submitted with your approved Form I-600A application (please attach a copy of your Form I-600A
approval notice).
D.
A.
Page 11 of 17Form I-600 Edition 12/21/19
Date
(mm/dd/yyyy)
Payee
Relationship to
Child (if any)
Purpose of Payment
Amount of Payment (or description
and value of in kind consideration)
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.
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 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.
2.
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 of 17Form I-600 Edition 12/21/19
3.
Part 4. Information About Fees, Expenses, and Other Compensation (continued)
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?
NoYes
If you answered "Yes," provide a detailed description to explain.
Part 5. Accommodations for Individuals With Disabilities and/or Impairments
1. Are you requesting an accommodation because of disabilities and/or impairments?
If you answered "Yes," select all applicable boxes below to indicate who has the disabilities and/or impairments.2.
Petitioner 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).):
3.
Yes No
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.):
NOTE: Read the information in the Form I-600 Instructions before completing this section.
Part 6. Petitioner's Statement, Certification, Duty of Disclosure, and Signature
Petitioner's Statement
NOTE: Read the Penalties section of the Form I-600 Instructions before completing this section.
every question in
The interpreter named in Part 8. read to me every question and instruction on this petition and my answer to
Petitioner's Statement Regarding the Interpreter (Select the box for either Item A. or B.)1.
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.
A.
B.
I understood everything.
, a language in which I am fluent, and
Petitioner's Statement Regarding the Preparer (if applicable)2.
At my request, the preparer named in Part 9.,
prepared this application for me based only upon information I provided or authorized.
,
Page 13 of 17Form I-600 Edition 12/21/19
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.
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:
2) I understood all of the information contained in, and submitted with, my petition; and
1) I reviewed and provided or authorized all of the information in my petition;
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.
3) All of this information was complete, true, and correct at the time of filing.
Petitioner's Signature Date of Signature (mm/dd/yyyy) 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.
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.
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.
Your Spouse's Statement
every question in
The interpreter named in Part 8. read to me every question and instruction on this petition and my answer to
Spouse's Statement Regarding the Interpreter (Select the box for either Item A. or B.)1.
I can read and understand English, and have read and understand every question and instruction on this petition and my
answer to every question.
A.
B.
and I understood everything.
, a language in which I am fluent,
Spouse's Statement Regarding the Preparer (if applicable)2.
At my request, the preparer named in Part 9.,
prepared this petition for me based only upon information I provided or authorized.
,
Page 14 of 17Form I-600 Edition 12/21/19
Part 7. Your Spouse's Statement, Certification, Duty of Disclosure, and Signature (continued)
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:
2) I understood all of the information contained in, and submitted with, my petition; and
1) I reviewed and provided or authorized all of the information in my petition;
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.
3) All of this information was complete, true, and correct at the time of filing.
Your Spouse's Signature
Your Spouse's Signature Date of Signature (mm/dd/yyyy) 3.
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 Given Name (First Name)Interpreter's Family Name (Last Name)1.
Interpreter's Full Name
Interpreter's Business or Organization Name (if any)2.
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.
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.
Page 15 of 17Form I-600 Edition 12/21/19
3.
City or Town
Postal CodeProvince
Street Number and Name Apt. Flr. NumberSte.
Country
Interpreter's Mailing Address
Interpreter's Contact Information
Interpreter's Daytime Telephone Number4. Interpreter's Mobile Telephone Number (if any)5.
Interpreter's Email Address (if any)6.
I am fluent in English and
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.
I certify, under penalty of perjury, that:
Interpreter's Certification
Interpreter's Signature
Interpreter's Signature Date of Signature (mm/dd/yyyy) 7.
, which is the same language specified in
Part 8. Interpreter's Contact Information, Certification, and Signature (continued)
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
Preparer's Given Name (First Name)Preparer's Family Name (Last Name)1.
Preparer's Business or Organization Name (if any)2.
State ZIP Code
Page 16 of 17Form I-600 Edition 12/21/19
Preparer's Mailing Address
3. Street Number and Name Apt. Flr. NumberSte.
City or Town State ZIP Code
Postal CodeProvince Country
Preparer's Contact Information
Preparer's Daytime Telephone Number 4.
Preparer's Mobile Telephone Number (if any)
5.
Preparer's Email Address (if any)6.
Preparer's Statement
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.
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 does not extend beyond the preparation of this petition.
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.
7.
A.
Preparer's Signature
Preparer's Signature Date of Signature (mm/dd/yyyy) 8.
Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Petition, If Other
Than the Petitioner and Spouse (continued)
extends
Page 17 of 17Form I-600 Edition 12/21/19
Part 10. Additional Information
5.
Page Number
Part Number Item Number6.
Item NumberPart NumberPage Number B.
B.
C.
C.
D.
D.
A.
A.
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.
A-Number (if any)
A-
3.
2.
Page Number B. Part Number C. Item Number
1. Family Name (Last Name) Given Name (First Name) Middle Name
D.
A.
Page Number Part Number Item Number
D.
4. B. C.A.