I have been previously married ___________ time(s).
If acquired through parentage, have you obtained a certificate in your
own name based on that acquisition?
If acquired through naturalization, give name under which naturalized,
number of naturalization certificate, and date and place of naturalization.
Department of Homeland Security
U.S. Citizenship and Immigration Services
Do not write in this block. For USCIS Use Only.
It has been determined that the:
Fee Stamp
Unmarried
There:
are not
are
preadoptive requirements in the State of the child's proposed
residence.
The following is a description of the preadoption requirements, if any,
of the State of the child's proposed residence:
DATE OF FAVORABLE
DETERMINATION
DD
DISTRICT
File number of applicant, if applicable.
The preadoption requirements, if any,:
have been met.
have not been met.
BLOCK I - Information about the prospective adoptive parent.
Date and place of present marriage
(First)
1. My name is: (Last)
Single
(C/O if appropriate)
(Apt. No.)
(Number and Street)
(Town or City)
(State)
(Zip Code)
(Apt. No.)
(Town or City)
(Province)
(Country)
(mm/dd/yyyy)
(State or Province)
(Country)
6. My telephone number is: (Include Area Code)
Name of present spouse (include maiden name of wife)
Date of birth of spouse
Place of birth of spouse
Number of prior marriages of spouse
With me
My spouse resides
Apart from me
(provide address below)
(Apt. No.)
(No. and Street)
(City)
(State)
Birth
Parents
Naturalization
If not, submit evidence of citizenship. See Instruction 2.a(2).
No
Yes
Widowed
Divorced
Have you or any person through whom you claimed citizenship ever lost
United States citizenship?
I have never been married.
No
4. Address abroad (If any):
(Number and Street)
prospective adoptive parent will furnish proper care to
a beneficiary orphan if admitted to the United States.
Yes (If Yes, attach detailed explanation.)
(Middle)
In:
(Town or City)
2. Other names used (including maiden name if appropriate):
3. I reside in the U.S. at:
5. I was born on:
7. My marital status is:
8. If you are now married, give the following information:
9. I am a citizen of the United States through:
Please type or print legibly in black ink.
This application is made by the named prospective adoptive parent for advance processing of an orphan petition.
Received
Trans. In
Completed
Ret'd Trans. Out
(mm/dd/yyyy)
(mm/dd/yyyy)
(Country)
OMB No. 1615-0028; Expires 08/31/08
I-600A, Application for Advance
Processing of Orphan Petition
Form I-600A (Rev. 07-30-07) Y
BLOCK II - General information.
Will the child come to the United States for adoption after compliance
with the preadoption requirements, if any, of the State of proposed
residence?
Name and address of organization or individual assisting you in
locating or identifying an orphan
(Name)
(Address)
No
Yes
Does your spouse, if any, plan to travel abroad to locate or adopt a
child?
Yes
No
If the answer to Question 11 or 12 is "Yes," give the
following information:
Yes
No
The USCIS office located at
The American Embassy or Consulate at
a. Your date of intended departure
If "Yes," how many children do you plan to adopt?
b. Your spouse's date of intended departure
c. City, province
Certification of prospective adoptive parent.
Certification of married prospective adoptive parent spouse.
(Signature of Prospective Adoptive Parent)
Executed on (Date)
Executed on (Date)
I certify, under penalty of perjury under the laws of the United States
of America, that the foregoing is true and correct and that I will care
for an orphan/orphans properly if admitted to the United States.
I certify, under penalty of perjury under the laws of the United States of
America, that the foregoing is true and correct and that my spouse and I
will care for an orphan/orphans properly if admitted to the United States.
Yes
No
10.
11.
Do you plan to travel abroad to locate or adopt a child?
12.
13.
15.
If the answer to Question 14 is "No," will the child be adopted abroad
after having been personally seen and observed by you and your
spouse, if married?
16.
Where do you wish to file your orphan petition?
17.
Do you plan to adopt more than one child?
(Signature of Prospective Adoptive Parent Spouse)
Signature of person preparing form, if other than petitioner.
I declare that this document was prepared by me at the request of the
petitioner and is based entirely on information of which I have knowledge.
(Signature)
Street Address and Room or Suite No./City/State/Zip Code
Executed on (Date)
No
Yes
Form I-600A (Rev. 07/30/07)Y Page 2
14.