Form I-508f - Request For Waiver Of Rights, Privileges, Exemptions, And Immunities For French Nationals Page 3

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Part 4. Interpreter's Contact Information, Certification, and Signature (continued)
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 Email Address (if any)
Interpreter's Certification
I certify that:
I am fluent in English and
, which is the same language provided
in Part 3., Item B. in Item Number 1.;
I have read to this requestor every question and instruction on this request, as well as the answer to every question, in the language
provided in Part 3., Item B. in Item Number 1.; and
The requestor has informed me that he or she understands every instruction and question on the request, as well as the answer to every
question, and the requestor verified the accuracy of every answer.
Interpreter's Signature
6.
Interpreter's Signature
Date of Signature (mm/dd/yyyy)
Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this
Request, If Other Than the Requestor
Provide the following information concerning the preparer.
Preparer's Full Name
1.
Preparer's Family Name (Last Name)
Preparer's Given Name (First Name)
2.
Preparer's Business or Organization Name (if any)
Form I-508F 05/26/17 N
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