Part 6. Interpreter's Contact Information,
Preparer's Mailing Address
Certification, and Signature (continued)
3.a.
Street Number
and Name
Interpreter's Contact Information
3.b.
Apt.
Ste.
Flr.
4.
Interpreter's Daytime Telephone Number
3.c. City or Town
5.
Interpreter's Mobile Telephone Number (if any)
3.d. State
3.e. ZIP Code
3.f.
Province
6.
Interpreter's Email Address (if any)
3.g.
Postal Code
3.h. Country
Interpreter's Certification
I certify, under penalty of perjury, that:
Preparer's Contact Information
I am fluent in English and
,
which is the same language specified in Part 5., Item Number
4.
Preparer's Daytime Telephone Number
1.b., and I have read to this petitioner in the identified language
every question and instruction on this petition and his or her
answer to every question. The petitioner informed me that he or
5.
Preparer's Mobile Telephone Number (if any)
she understands every instruction, question, and answer on the
petition, including the Petitioner's Declaration and
Certification, and has verified the accuracy of every answer.
6.
Preparer's Email Address (if any)
Interpreter's Signature
7.a.
Interpreter's Signature (sign in ink)
Preparer's Statement
I am not an attorney or accredited representative but
7.a.
have prepared this petition on behalf of the petitioner
7.b.
Date of Signature (mm/dd/yyyy)
and with the petitioner's consent.
I am an attorney or accredited representative and my
7.b.
Part 7. Contact Information, Declaration, and
representation of the petitioner in this case
Signature of the Person Preparing this Petition, if
extends
does not extend beyond the
preparation of this petition.
Other Than the Petitioner
NOTE: If you are an attorney or accredited
Provide the following information about the preparer.
representative whose representation extends beyond
preparation of this petition, you may be obliged to
Preparer's Full Name
submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative,
1.a. Preparer's Family Name (Last Name)
or G-28I, Notice of Entry of Appearance as Attorney
In Matters Outside the Geographical Confines of the
United States, with this petition.
1.b.
Preparer's Given Name (First Name)
2.
Preparer's Business or Organization Name (if any)
Form I-129F 04/10/17 N
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