Form I-600 - Petition To Classify Orphan As An Immediate Relative Page 10
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14Part 5. Petitioner's Statement, ASC Acknowledgement (if applicable), Certification, Signature, and
Contact Information (continued)
Acknowledgement of Appointment at USCIS Application Support Center (if applicable)
I,
,
understand that the purpose of a USCIS Application Support Center (ASC) appointment is for me to provide my fingerprints,
photograph, and/or signature and to reverify that all of the information in my petition is complete, true, and correct and was provided
by me. I understand that I will sign my name to the following declaration which USCIS will display to me at the time I provide my
fingerprints, photograph, and/or signature during my ASC appointment:
By signing here, I declare under penalty of perjury that I have reviewed and understand this petition as identified by the
receipt number displayed on the screen above, and all supporting documents, applications, petitions, or requests filed with this
petition that I (or my attorney or accredited representative) filed with USCIS, and that all of the information in these materials
is complete, true, and correct.
I also understand that when I sign my name, provide my fingerprints, and am photographed at the USCIS ASC, I will be reverifying that
I willingly submit this petition; I have reviewed the contents of this petition; all of the information in my petition and all supporting
documents submitted with my petition are complete, true, and correct; and if I was assisted in completing this petition, the person
assisting me also reviewed this Acknowledgement of Appointment at USCIS Application Support Center (if applicable) with me.
Petitioner's Certification
I certify, under penalty of perjury under the laws of the United States of America, that the information in this petition and any
document submitted with this petition is complete, true, and correct.
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from my
records that USCIS may need to determine whether the child I am petitioning for is eligible to be classified as my immediate relative.
I furthermore authorize release of information contained in this petition, in supporting documents, and in my USCIS records, to other
entities and persons where necessary for the administration of U.S. immigration laws.
Petitioner's Signature
3.
Petitioner's Signature
Date of Signature
►
(mm/dd/yyyy)
Petitioner's Contact Information
4.
Petitioner's Daytime Telephone Number
5.
Petitioner's Mobile Telephone Number (if any)
6.
Petitioner's Email Address (if any)
Part 6. Petitioner's Duty of Disclosure
Certification: I understand the ongoing duty to disclose information concerning my suitability and eligibility as an adoptive parent, as
described in the Form I-600 and/or I-600A instructions, and I agree to notify the home study preparer and USCIS of any new information
that I am required to disclose.
Petitioner's Signature
Date of Signature
►
(mm/dd/yyyy)
Form I-600 12/23/16 N
Page 10 of 14
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