Form I-360 - Petition For Amerasian, Widow(Er), Or Special Immigrant Page 7
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19Part 6. Complete Only If Filing for an Amerasian (continued)
C.
If you answered "No" to Item A. in Item Number 2., provide her date of death (mm/dd/yyyy).
Information About the Father of the Amerasian
If possible, attach a notarized statement from the father regarding parentage. If there is a question you cannot fully answer in the
space provided on this petition, use the space provided in Part 15. Additional Information.
3.
Father's Full Name
Family Name (Last Name)
Given Name (First Name)
Middle Name
4.
Date of Birth (mm/dd/yyyy)
5.
Country of Birth
6.
A.
Is the father still alive?
Unknown
Yes
No
B.
If you answered "Yes" to Item A. in Item Number 6., provide his 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
C.
If you answered "No" to Item A. in Item Number 6., provide his date of death (mm/dd/yyyy).
D.
Daytime Telephone Number (if any)
E.
Work Telephone Number (if any)
At the time the Amerasian was conceived:
7.
A.
The father was in the military (indicate branch of service below).
Army
Air Force
Navy
Marine Corps
Coast Guard
B.
Provide the father's service number:
C.
The father was not in the military and was not a civilian employed abroad. (Attach a full explanation of the
circumstances.)
Part 7. Complete Only If Filing as a Widow/Widower
1.
Full Name of U.S. Citizen Husband or Wife Who Died
Family Name (Last Name)
Given Name (First Name)
Middle Name
2.
Date of Birth (mm/dd/yyyy)
3.
Country of Birth
4.
Date of Death (mm/dd/yyyy)
Form I-360 12/23/16 N
Page 7 of 19
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