Supplement 1 For Form I-600 And I-600a - Petition To Classify Orphan As An Immediate Relative

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Supplement 1,
USCIS
Listing of Adult Member of the Household
Form I-600A/I-600
Supplement 1
Department of Homeland Security
OMB No. 1615-0028
U.S. Citizenship and Immigration Services
Expires 12/31/2018
Part 1. Information About an Adult Member of the Household
You must complete Form I-600A/Form I-600, Supplement 1, for each adult member of your household 18 years of age or older.
Note you do not need to complete one for yourself or your spouse (if married).
Provide the following information about the Adult Member of the Household:
1.
Family Name (Last Name)
Given Name (First Name)
Middle Name (if applicable)
2.
Other Names You Have Used (including maiden name, nicknames, and aliases, if any)
Family Name (Last Name)
Given Name (First Name)
Middle Name (if applicable)
3.
U.S. Mailing Address (if any)
In Care Of Name
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
4.
Is your current U.S. mailing address the same as your U.S. physical address?
Yes
No
If you answered "No" to Item Number 4., provide your U.S. physical address in Item Number 5. or your address abroad in Item
Number 6., as appropriate.
5.
U.S. Physical Address (if any)
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
6.
Address Abroad (if any)
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
Province
Postal Code
Country
7. Date of Birth (mm/dd/yyyy)
8.
City/Town/Village of Birth
Form I-600A/I-600 Supplement 1 12/23/16 N
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