Form I-90 - Application To Replace Permanent Resident Card Page 6
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7Part 7. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
(continued)
Preparer's Statement
I am not an attorney or accredited representative but
7.a.
have prepared this application on behalf of the
applicant and with the applicant's consent.
I am an attorney or accredited representative and my
7.b.
representation of the applicant in this case
extends
does not extend beyond the
preparation of this application.
NOTE: If you are an attorney or accredited
representative whose representation extends beyond
preparation of this application, you may be obliged to
submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited
Representative, with this application.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant. The
applicant then reviewed this completed application and
informed me that he or she understands all of the information
contained in, and submitted with, his or her application,
including the Applicant's Certification, and that all of this
information is complete, true, and correct. I completed this
application based only on information that the applicant
provided to me or authorized me to obtain or use.
Preparer's Signature
8.a. Preparer's Signature (sign in ink)
8.b. Date of Signature (mm/dd/yyyy)
Form I-90 02/27/17 N
Page 6 of 7
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