Form I-600 - 2011 Petition To Classify Orphan As An Immediate Relative Page 2

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BLOCK I - Information About the Prospective Adoptive Parent (Continued)
8. My marital status is:
a.
Married
Widowed
Divorced
Single
b. I have been married
time(s)
9. If you are now married, provide the following information:
Date of present marriage (mm/dd/yyyy):
Place of present marriage:
Name of present spouse:
(Last)
(First)
(Middle)
(Maiden, if any)
Date of birth of present spouse (mm/dd/yyyy):
Place of birth of present spouse:
My spouse has been married
time(s)
My spouse resides:
With me
Apart from me (provide address below)
(Number and Street)
(Apt. No.)
(City)
(State)
(Country)
BLOCK II - Information About Orphan Beneficiary
10. Name at birth:
(Last)
(First)
(Middle)
11. Name at present:
(Last)
(First)
(Middle)
12. Any other names by which orphan is or was known:
13. Gender:
Male
Female
14. Date of birth (mm/dd/yyyy):
15. Place of birth:
(City)
(State or Province)
(Country)
16. The beneficiary is an orphan because (check one):
He or she has no parents
He or she has only one parent who
is the sole or surviving parent
17. If the orphan has only one parent, answer the following:
a. State what has become of the other parent:
b. Is the remaining parent capable of providing for the orphan's support?
No
Yes
c. Has the remaining parent in writing irrevocably released the orphan for emigration and adoption?
No
Yes
Form I-600 (Rev. 01/12/11) Y Page 2

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