Form I-360 - Petition For Amerasian, Widow(Er), Or Special Immigrant
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19Petition for Amerasian, Widow(er), or Special Immigrant
USCIS
Form I-360
Department of Homeland Security
OMB No. 1615-0020
U.S. Citizenship and Immigration Services
Expires 03/31/2018
Action Block
For USCIS Use Only
Fee Stamp
Returned
Resubmitted
Received
Relocated
Sent
Remarks:
Classification
Petitioner/Applicant
Interviewed
Interviewed Beneficiary
Interviewed
Consulate
I-485 Filed Concurrently
Priority Date
Bene "A" File Reviewed
Attorney State Bar Number
Attorney or Accredited Representative
Select this box if
To be completed by an
(if applicable)
USCIS Online Account Number (if any)
Form G-28 or
Attorney or Accredited
G-28I is attached.
Representative (if any).
►
START HERE - Type or print in black ink.
Part 1. Information About Person or Organization Filing This Petition
NOTE: You must complete Part 1. as the petitioner if you are filing this petition on behalf of another person. If you are a Violence
Against Women Act (VAWA) self-petitioner or special immigrant juvenile, skip to Part 1., Item Number 7.
1.
Your Full Name
Family Name (Last Name)
Given Name (First Name)
Middle Name
2.
USCIS Online Account Number (if any)
3.
U.S. Social Security Number (if any)
►
►
4.
Alien Registration Number (A-Number) (if any)
5.
Individual IRS Tax Number (if any)
►
►
A-
6.
Mailing Address
In Care Of Name (if any)
Organization Name (if applicable)
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
Province
Postal Code
Country
Form I-360 12/23/16 N
Page 1 of 19
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