Form I-800a - Application For Determination Of Suitability To Adopt A Child From A Convention Country Page 5
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9Part 2.
Information About Your Spouse
(Continued)
2. Date Marriage Ended
Name of
How Marriage
(mm/dd/yyyy)
Prior Spouse
Ended
Divorce
Death
Other
NOTE: If you need more space to complete, use a separate sheet of paper. Write your name and USCIS Account Number, if
known, at the top of each sheet of paper and indicate the part and number of the item to which the answer refers.
4. Your spouse:
Is a citizen of the United States through:
Birth in the United States
Parent(s)
Naturalization
Is a non-citizen national of the United States.
Is an alien who has been lawfully admitted for permanent residence.
Is an alien who has not been lawfully admitted for permanent residence. (Provide a full explanation on a separate sheet of
paper. Copies of any relevant documents relating to any other immigration status must be attached to Form I-800A. If your
spouse is an alien who does not live in the United States, provide a complete explanation.)
5. If your spouse derived citizenship through his or her parent(s), has he or she obtained his or her own
Yes
No
certificate of citizenship?
If "Yes," provide the following information:
Name Under Which Certificate of Citizenship Was Issued
Certificate of
Date of Issuance
Place of
A #
Citizenship Number
(mm/dd/yyyy)
Issuance
(if known)
6. If your spouse became a citizen by naturalization, give the following information:
Name Under Which Certificate of Naturalization Was Issued
Naturalization
Date of Naturalization
Place of
A #
Certificate Number
(mm/dd/yyyy)
Naturalization
(if known)
7. Has your spouse, or any person through whom he or she claimed citizenship, ever lost U.S. citizenship?
Yes
No
If "Yes," attach a detailed explanation on a separate sheet of paper.
8. Has your spouse ever, whether in or outside the United States:
a. Been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any
Yes
No
law or ordinance, excluding traffic violations, but including driving or operating a vehicle while
intoxicated or while impaired by or under the influence of alcohol or other intoxicant?
Form I-800A (Rev. 03/10/17) N Page 5
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