Form I-485 - Application To Register Permanent Residence Or Adjust Status Page 6
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6Part 5. Signature (Continued)
Applicant's Statement (Check one)
I can read and understand English, and I have read and understand each and every question and instruction on this form, as well
as my answer to each question.
Each and every question and instruction on this form, as well as my answer to each question, has been read to me in the
language, a language in which I am fluent, by the person named in Interpreter's Statement and
Signature. I understand each and every question and instruction on this form, as well as my answer to each question.
I certify, under penalty of perjury under the laws of the United States of America, that the information provided with this application is
all true and correct. I certify also that I have not withheld any information that would affect the outcome of this application.
I authorize the release of any information from my records that U.S. Citizenship and Immigration Services (USCIS) needs to
determine eligibility for the benefit I am seeking.
Date
Daytime Phone Number
(mm/dd/yyyy)
(include area code)
Signature (Applicant)
Print Your Full Name
NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be found
eligible for the requested benefit, and this application may be denied.
Interpreter's Statement and Signature
I certify that I am fluent in English and the below-mentioned language.
Language Used (language in which applicant is fluent)
I further certify that I have read each and every question and instruction on this form, as well as the answer to each question, to this
applicant in the above-mentioned language, and the applicant has understood each and every instruction and question on the form, as
well as the answer to each question.
Date
Phone Number
(mm/dd/yyyy)
(include area code)
Signature (Interpreter)
Print Your Full Name
Part 6. Signature of Person Preparing Form, If Other Than Above
I declare that I prepared this application at the request of the above applicant, and it is based on all information of which I have knowledge.
Date
Phone Number
(mm/dd/yyyy)
(include area code)
Signature
Print Your Full Name
Firm Name and Address
E-Mail Address (if any)
Form I-485 (Rev. 07/15/10) Y Page 6
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