Form I-130a - Supplemental Information For Spouse Beneficiary Page 4
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6Part 5. Interpreter's Contact Information,
Interpreter's Certification
Certification, and Signature
I certify, under penalty of perjury, that:
Provide the following information about the interpreter you used
I am fluent in English and
,
to complete Form I-130A if he or she is different from the
which is the same language provided in Part 4., Item Number
interpreter used to complete the Form I-130 filed on your behalf.
1.b., and I have read to this spouse beneficiary in the identified
language every question and instruction on this form and his or
Interpreter's Full Name
her answer to every question. The spouse beneficiary informed
me that he or she understands every instruction, question, and
1.a.
Interpreter's Family Name (Last Name)
answer on the form, including the Spouse Beneficiary's
Certification, and has verified the accuracy of every answer.
1.b.
Interpreter's Given Name (First Name)
Interpreter's Signature
7.a.
Interpreter's Signature (sign in ink)
2.
Interpreter's Business or Organization Name (if any)
7.b.
Date of Signature (mm/dd/yyyy)
Interpreter's Mailing Address
3.a.
Street Number
Part 6. Contact Information, Declaration, and
and Name
Signature of the Person Preparing this Form, if
3.b.
Apt.
Ste.
Flr.
Other Than the Spouse Beneficiary
Provide the following information about the preparer you used
3.c. City or Town
to complete Form I-130A if he or she is different from the
preparer used to complete the Form I-130 filed on your behalf.
3.d. State
3.e. ZIP Code
Preparer's Full Name
3.f.
Province
1.a. Preparer's Family Name (Last Name)
3.g.
Postal Code
3.h. Country
1.b.
Preparer's Given Name (First Name)
Interpreter's Contact Information
2.
Preparer's Business or Organization Name (if any)
4.
Interpreter's Daytime Telephone Number
Preparer's Mailing Address
5.
Interpreter's Mobile Telephone Number (if any)
3.a.
Street Number
and Name
6.
Interpreter's Email Address (if any)
3.b.
Apt.
Ste.
Flr.
3.c. City or Town
3.d. State
3.e. ZIP Code
3.f.
Province
3.g.
Postal Code
3.h. Country
Form I-130A 02/27/17 N
Page 4 of 6
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