Part 3. Adult Member of the Household's Statement, Contact Information, Certification, and Signature
Adult Member of the Household's Statement
Select the box for either Item Number 1.A. or 1.B. If applicable, select the box for Item Number 2.
I can read and understand English, and have read and understand every question and instruction on this supplement, as well as
1.A.
my answer to every question.
1.B.
The interpreter named in Part 6. has read to me every question and instruction on this supplement, as well as my answer
to every question, in
, a language in which I am fluent.
I understand every question and instruction on this supplement as translated to me by my interpreter, and have provided
complete, true, and correct responses.
2.
I have requested the services of and consented to
,
who
is
is not an attorney or accredited representative, preparing this supplement for me.
Adult Member of the Household's Contact Information
3.
Adult Member of the Household's Daytime Telephone Number
4.
Adult Member of the Household's Mobile Telephone Number (if any)
5.
Adult Member of the Household's Email Address (if any)
Adult Member of the Household's Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
any
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from
and all of my
records that USCIS may need to determine the suitability and eligibility of the applicant or petitioner as an adoptive
parent.
I furthermore authorize release of information contained in this supplement, in supporting documents, and in my USCIS records to
other entities and persons where necessary for the administration of U.S. immigration laws.
I certify, under penalty of perjury, that the information in my supplement and any document submitted with my supplement is
complete, true, and correct.
Adult Member of the Household's Signature
6.
Adult Member of the Household's Signature
Date of Signature
(mm/dd/yyyy)
Part 4. Adult Member of the Household's Duty of Disclosure
Certification: I understand the ongoing duty to disclose information concerning any change of circumstance, as described in the
Form I-600A and/or Form I-600 instructions, and I agree to notify the applicant, petitioner, and/or home study preparer and USCIS of
any new information that I am required to disclose.
Adult Member of the Household's Signature
Date of Signature
(mm/dd/yyyy)
Form I-600A/I-600 Supplement 1 12/23/16 N
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