Supplement 1 For Form I-600 And I-600a - Petition To Classify Orphan As An Immediate Relative Page 5

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Part 6. Interpreter's Name, 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
.
I have read to this adult member of the household and/or applicant or petitioner every question and instruction on this supplement, as
well as the answer to every question in the language in which he and/or she is fluent; and
The adult member of the household and/or applicant or petitioner has informed me that he and/or she understands every instruction
and question on the supplement, as well as his and/or her answers to every question, and the adult member of the household and/or
applicant or petitioner verified the accuracy of every answer.
Interpreter's Signature
6.
Interpreter's Signature
Date of Signature
(mm/dd/yyyy)
Part 7. Name, Contact Information, Statement, Certification, and Signature of the Person Preparing
this Supplement, If Other Than the Adult Member of the Household, and/or Applicant or Petitioner
If the adult member of the household and/or applicant or petitioner used a preparer to complete this supplement, the preparer must
provide the following information:
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-600A/I-600 Supplement 1 12/23/16 N
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