Form I-600 - 2009 Petition To Classify Orphan As An Immediate Relative (Page 4 of 4) in pdf

Form I-600 - 2009 Petition To Classify Orphan As An Immediate Relative Page 4

BLOCK II - Information About Orphan Beneficiary

(Continued)

29. Location of U.S. Embassy or consulate where application for visa will be made:

(City in Foreign Country)

(Foreign Country)

BLOCK III - Accommodations for Individuals With Disabilities and Impairments (Read the information in the instructions

before completing this section.)

30. I am requesting an accommodation:

A. Because of my disability(ies) and/or impairment(s).

Yes

B. For my spouse because of his or her disability(ies) and/or impairment(s).

Yes

C. For my household member because of his or her disability(ies) and/or impairment(s).

If you answered "Yes," check any applicable box. Provide information on the disability(ies) and/or impairment(s) for each

person:

Deaf or hard of hearing and request the following accommodation(s) (if requesting a sign-language interpreter, indicate

which language (e.g., American Sign Language)):

Blind or sight-impaired and request the following accommodation(s):

Other type of disability(ies) and/or impairment(s) (describe the nature of the disability(ies) and/or impairment(s) and

accommodation(s) being requested):

Certification of Petitioner

Certification of Married Prospective Petitioner's Spouse

I certify, under penalty of perjury under the laws of the United States

of America, that the foregoing is true and correct, and that I will care

of America, that the foregoing is true and correct, and that my

for an orphan or orphans properly if admitted to the United States.

spouse and I will care for an orphan or orphans properly if admitted

to the United States.

(Signature of Petitioner)

(Signature of Petitioner's Spouse)

Executed on (Date)

Signature of Person Preparing Form, If Other Than Petitioner

I declare that this document was prepared by me at the request of the petitioner and is based entirely on information of which I have knowledge.

(Signature)

Executed on (Date)

Street Address and Room or Suite No./City/State/Zip Code

Form I-600 (Rev. 12/30/09) N Page 4

Form I-600 - 2009 Petition To Classify Orphan As An Immediate Relative Page 4