Interpreter's Contact Information
Part 4. Applicant's Statement, Contact
Information, Certification, and Signature
4.
Interpreter's Daytime Telephone Number
(continued)
5.
Interpreter's Email Address (if any)
Applicant's Signature
6.a.
Applicant's Signature
Interpreter's Certification
6.b. Date of Signature (mm/dd/yyyy)
I certify that:
I am fluent in English and
, which
NOTE TO ALL APPLICANTS: If you do not completely fill
is the same language provided in Part 4., Item Number 1.b.;
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.
I have read to this applicant every question and instruction on
this application, as well as the answer to every question, in the
language provided in Part 4., Item Number 1.b.; and
Part 5. Interpreter's Contact Information,
The applicant has informed me that he or she understands every
Certification, and Signature
instruction and question on the application, as well as the
answer to every question, and the applicant verified the
Provide the following information about the interpreter.
accuracy of every answer.
Interpreter's Full Name
Interpreter's Signature
1.a. Interpreter's Family Name (Last Name)
6.a.
Interpreter's Signature
1.b. Interpreter's Given Name (First Name)
6.b.
Date of Signature (mm/dd/yyyy)
2.
Interpreter's Business or Organization Name (if any)
Part 6. Contact Information, Statement,
Certification, and Signature of the Person
Preparing This Application, If Other Than the
Interpreter's Mailing Address
Applicant
3.a.
Street Number
and Name
Provide the following information about the preparer.
3.b.
Apt.
Ste.
Flr.
Preparer's Full Name
3.c. City or Town
1.a. Preparer's Family Name (Last Name)
3.d. State
3.e. ZIP Code
1.b. Preparer's Given Name (First Name)
3.f.
Province
3.g.
Postal Code
2.
Preparer's Business or Organization Name (if any)
3.h. Country
Form I-824 12/23/16 N
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