Form I-360 - Petition For Amerasian, Widow(Er), Or Special Immigrant Page 6

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Part 5. Information About the Spouse and Children of the Beneficiary (continued)
8.
Person 7
Family Name (Last Name)
Given Name (First Name)
Middle Name
Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A-Number (if any)
►
A-
Child
9.
Person 8
Family Name (Last Name)
Given Name (First Name)
Middle Name
Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A-Number (if any)
►
A-
Child
10.
Person 9
Family Name (Last Name)
Given Name (First Name)
Middle Name
Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A-Number (if any)
►
Child
A-
Part 6. Complete Only If Filing for an Amerasian
Information About the Mother of the Amerasian
1.
Mother's Full Name
Family Name (Last Name)
Given Name (First Name)
Middle Name
2.
A.
Is the mother still alive?
Unknown
Yes
No
B. If you answered "Yes" to Item A. in Item Number 2., provide her address below.
In Care Of Name (if any)
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 6 of 19

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