Form I-539 - Application To Extend/change Nonimmigrant Status Page 4
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9Interpreter Certification
Part 5. Applicant's Statement, Contact Information,
Certification and Signature (continued)
I certify that:
I am fluent in English and
, which
Applicant's Contact Information
is the same language provided in Part 5., Item Number 1.b.;
4.
Applicant's Daytime Telephone Number
I have read to this applicant every question and instruction on
this form, as well as the answer every question, in the language
provided in Part 5., Item Number 1.b.; and
5.
Applicant's Mobile Telephone Number
The applicant has informed me that he or she understands every
instruction and question on the form, as well as the answer to every
question, and the applicant verified the accuracy of every answer..
6.
Applicant's E-mail Address
6.a.
Interpreter's Signature
Part 6. Contact Information, Statement,
►
6.b.
Date of Signature
(mm/dd/yyyy)
Certification, and Signature of the Interpreter
Interpreter's Full Name
Part 7. Contact Information, Certification, and
Signature of the Person Preparing this
Provide the following information concerning the interpreter:
Application, If Other Than the Applicant
1.a.
Interpreter's Family Name (Last Name)
Preparer's Full Name
1.b.
Interpreter's Given Name (First Name)
Provide the following information concerning the preparer:
1.a. Preparer's Family Name (Last Name)
2.
Interpreter's Business or Organization Name (if any)
1.b.
Preparer's Given Name (First Name)
Interpreter's Mailing Address
2.
Preparer's Business or Organization Name
3.a.
Street Number
and Name
3.b. Apt.
Ste.
Flr.
Preparer's Mailing Address
3.c. City or Town
3.a.
Street Number
and Name
3.d. State
3.e. ZIP Code
3.b. Apt.
Ste.
Flr.
3.f.
Province
3.c. City or Town
3.g. Postal Code
3.d. State
3.e. ZIP Code
3.h.
Country
3.f.
Province
3.g. Postal Code
Interpreter's Contact Information
3.h.
Country
4.
Interpreter's Daytime Telephone Number
5.
Interpreter's E-mail Address
Form I-539 12/23/16 N
Page 4 of 9
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