Form I-129 - Petition For A Nonimmigrant Worker - Department Of Homeland Security Page 12
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36Section 3. Declaration, Signature, and Contact Information of Person Preparing Form, If Other Than
Petitioner
Provide the following information concerning the preparer:
1.
Name of Preparer
Family Name (last name)
Given Name (first name)
2.
Preparer's Business or Organization Name (if any)
(If applicable, provide the name of your accredited organization recognized by the Board of Immigration Appeals (BIA)).
3.
Preparer's Mailing Address
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
Postal Code
Province
Country
4.
Preparer's Contact Information
Fax Number
Daytime Telephone Number
Email Address (if any)
Preparer's Declaration
By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this petition on behalf of, at the request of, and
with the express consent of the petitioner or authorized signatory. The petitioner has reviewed this completed petition as prepared by
me and informed me that all of the information in the form and in the supporting documents, is complete, true, and correct.
5.
Signature and Date
Signature of Preparer
Date of Signature
(mm/dd/yyyy)
Form I-129 08/13/15 Y
Trade Agreement Supplement
Page 12 of 36
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