Part 5. Applicant's or Petitioner's Statement, Contact Information, Certification, and Signature
Applicant's or Petitioner'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.
Applicant's or Petitioner's Contact Information
3.
Applicant's or Petitioner's Daytime Telephone Number
4.
Applicant's or Petitioner's Mobile Telephone Number (if any)
5.
Applicant's or Petitioner's Email Address (if any)
Applicant's or Petitioner'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 my suitability and eligibility 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.
Applicant's or Petitioner's Signature
6.
Applicant's or Petitioner's Signature
Date of Signature
(mm/dd/yyyy)
Part 6. Interpreter's Name, Contact Information, Certification, and Signature
If the adult member of the household and/or applicant or petitioner used an interpreter, the interpreter must provide the following
information:
Interpreter's Full Name
1.
Interpreter's Family Name (Last Name)
Interpreter's Given Name (First Name)
2.
Interpreter's Business or Organization Name (if any)
Form I-600A/I-600 Supplement 1 12/23/16 N
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