Form I-864w - Request For Exemption For Intending Immigrant'S Affidavit Of Support Page 4
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5Part 5. Contact Information, Statement,
Certification, and Signature of the Person
Preparing this Request, If Other than the
Requestor (continued)
Preparer's Statement
I am not an attorney or accredited representative but
7.a.
have prepared this request on behalf of the requestor
and with the requestor's consent.
I am an attorney or accredited representative and my
7.b.
representation of the requestor in this case
extends
does not extend beyond the
preparation of this request.
NOTE: If you are an attorney or accredited
representative whose representation extends beyond
preparation of this request, you must submit a
completed Form G-28, Notice of Entry of Appearance
as Attorney or Accredited Representative, with this
request.
Preparer's Certification
By my signature, I certify, swear, or affirm, under penalty of
perjury, that I prepared this request on behalf of, at the request
of, and with the express consent of the requestor. I completed
this request based only on responses the requestor provided to
me. After completing the request, I reviewed it and all of the
requestor's responses with the requestor, who agreed with every
answer on the request. If the requestor supplied additional
information concerning a question on the request, I recorded it
on the request.
Preparer's Signature
8.a. Preparer's Signature
8.b. Date of Signature (mm/dd/yyyy)
Form I-864W 07/02/15 N
Page 4 of 5
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