Form I-212 - Application For Permission To Reapply For Admission Into The United States After Deportation Or Removal Page 7

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Part 7. Contact Information, Statement,
Certification, 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
7.a.
but have prepared this application on behalf of
the applicant and with the applicant's consent.
I am an attorney or accredited representative and
7.b.
my 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 must
submit a completed Form G-28, Notice of
Entry of Appearance as Attorney or Accredited
Representative, or G-28I, Notice of Entry of
Appearance as Attorney In Matters Outside the
Geographical Confines of the United States,
with this application.
Preparer's Certification
By my signature, I certify, swear, or affirm, under penalty of
perjury, that I prepared this application on behalf of, at the request
of, and with the express consent of the applicant. I completed this
application based only on responses the applicant provided to me.
After completing the application, I reviewed it and all of the
applicant's responses with the applicant, who agreed with every
answer on the application. If the applicant supplied additional
information concerning a question on the application, I recorded it
on the application. I have also read the Acknowledgement of
Appointment at USCIS Application Support Center to the
applicant and the applicant has informed me that he or she
understands the ASC Acknowledgement.
Preparer's Signature
8.a. Preparer's Signature
8.b. Date of Signature (mm/dd/yyyy)
Form I-212 12/23/16 N
Page 7 of 8

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