Form I-361 - Affidavit Of Financial Support And Intent To Petition For Legal Custody For Public Law 97-359 Amerasian Page 6

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Interpreter's Signature
Part 5. Interpreter's Contact Information,
Certification, and Signature
6.a.
Interpreter's Signature
Provide the following information concerning the interpreter.
6.b.
Date of Signature (mm/dd/yyyy)
Interpreter's Full Name
1.a. Interpreter's Family Name (Last Name)
Part 6. Contact Information, Statement,
Certification, and Signature of the Person
1.b. Interpreter's Given Name (First Name)
Preparing This Affidavit, If Other Than the
Sponsor
2.
Interpreter's Business or Organization Name (if any)
Provide the following information concerning the preparer.
Preparer's Full Name
Interpreter's Mailing Address
1.a. Preparer's Family Name (Last Name)
3.a.
Street Number
and Name
1.b. Preparer's Given Name (First Name)
3.b.
Apt.
Ste.
Flr.
3.c. City or Town
2.
Preparer's Business or Organization Name (if any)
3.d. State
3.e. ZIP Code
Preparer's Mailing Address
3.f.
Province
3.a.
Street Number
3.g.
Postal Code
and Name
3.h. Country
3.b.
Apt.
Ste.
Flr.
3.c. City or Town
Interpreter's Contact Information
3.d. State
3.e. ZIP Code
4.
Interpreter's Daytime Telephone Number
3.f.
Province
3.g.
Postal Code
5.
Interpreter's Email Address (if any)
3.h. Country
Interpreter's Certification
Preparer's Contact Information
I certify that:
I am fluent in English and
, which
4.
Preparer's Daytime Telephone Number
is the same language provided in Part 4., Item Number 1.b.;
I have read to this applicant every question and instruction on
5.
Preparer's Fax Number
this affidavit, as well as the answer to every question, in the
language provided in Part 4., Item Number 1.b.; and
The applicant has informed me that he or she understands every
6.
Preparer's Email Address (if any)
instruction and question on the affidavit, as well as the answer
to every question, and the affidavit verified the accuracy of
every answer.
Form I-361 09/11/15 N
Page 6 of 8

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