Form I-9 - Supplement - Section 1 Preparer And/or Translator Certification

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Form I-9 Supplement,
USCIS
Section 1 Preparer and/or Translator Certification
Form I-9
Supplement
Department of Homeland Security
OMB No. 1615-0047
U.S. Citizenship and Immigration Services
Expires 08/31/2019
Middle Initial
Last Name (Family Name)
First Name (Given Name)
Employee Name:
Instructions: This supplement may be used if extra spaces are required to document more than one preparer and/or translator
assisting an employee in completing Section 1 of Form I-9. The preparer and/or translator must enter the employee's name in
the spaces provided. Each preparer or translator must complete, sign and date a separate certification area. Employers must
retain completed supplement sheets with the employee's completed Form I-9.
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my
knowledge the information is true and correct.
Signature of Preparer or Translator
Today's Date (mm/dd/yyyy)
Last Name (Family Name)
First Name (Given Name)
Address (Street Number and Name)
City or Town
State
ZIP Code
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my
knowledge the information is true and correct.
Signature of Preparer or Translator
Today's Date (mm/dd/yyyy)
Last Name (Family Name)
First Name (Given Name)
Address (Street Number and Name)
City or Town
State
ZIP Code
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my
knowledge the information is true and correct.
Signature of Preparer or Translator
Today's Date (mm/dd/yyyy)
Last Name (Family Name)
First Name (Given Name)
Address (Street Number and Name)
City or Town
State
ZIP Code
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my
knowledge the information is true and correct.
Signature of Preparer or Translator
Today's Date (mm/dd/yyyy)
Last Name (Family Name)
First Name (Given Name)
Address (Street Number and Name)
City or Town
State
ZIP Code
Form I-9 Supplement 07/17/17 N
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