Form I-360 - Petition For Amerasian, Widow(Er), Or Special Immigrant Page 17
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19Part 13. Interpreter's Contact Information, Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Full Name
1.
Interpreter's Family Name (Last Name)
Interpreter's Given Name (First Name)
2.
Interpreter's Business or Organization Name (if any)
Interpreter's Mailing Address
3.
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
Province
Postal Code
Country
Interpreter's Contact Information
4.
Interpreter's Daytime Telephone Number
5.
Interpreter's Mobile Telephone Number (if any)
6.
Interpreter's Email Address (if any)
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
, which is the same language specified in Part 11., Item B. in
Item Number 1., or in Part 12., Item B. in Item Number 1., and I have read to this petitioner or the authorized signatory in the
identified language every question and instruction on this petition and his or her answer to every question. The petitioner or
authorized signatory informed me that he or she understands every instruction, question, and answer on the petition, including the
Petitioner's Declaration and Certification, or Petitioner's or Authorized Signatory's Declaration and Certification, and has
verified the accuracy of every answer.
Interpreter's Signature
7.
Interpreter's Signature (sign in ink)
Date of Signature (mm/dd/yyyy)
Form I-360 12/23/16 N
Page 17 of 19
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