Form I-865 - Sponsor'S Notice Of Change Of Address Page 3
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5Interpreter's Signature
Part 4. Interpreter's Contact Information,
Certification, and Signature
6.a.
Interpreter's Signature
Provide the following information about the interpreter.
6.b.
Date of Signature (mm/dd/yyyy)
Interpreter's Full Name
1.a.
Interpreter's Family Name (Last Name)
Part 5. Contact Information, Statement,
Certification, and Signature of the Person
1.b.
Interpreter's Given Name (First Name)
Preparing this Notice, If Other Than the Sponsor
Provide the following information about the preparer.
2.
Interpreter's Business or Organization Name (if any)
Preparer's Full Name
1.a. Preparer's Family Name (Last Name)
Interpreter's Mailing Address
3.a.
Street Number
and Name
1.b.
Preparer's Given Name (First Name)
3.b.
Apt.
Ste.
Flr.
2.
Preparer's Business or Organization Name (if any)
3.c. City or Town
3.d. State
3.e. ZIP Code
Preparer's Mailing Address
3.f.
Province
3.a.
Street Number
3.g.
Postal Code
and Name
3.b.
Apt.
Ste.
Flr.
3.h.
Country
3.c. City or Town
Interpreter's Contact Information
3.d. State
3.e. ZIP Code
4.
Interpreter's Daytime Telephone Number
3.f.
Province
3.g.
Postal Code
5.
Interpreter's Email Address (if any)
3.h.
Country
Interpreter's Certification
Preparer's Contact Information
I certify that:
4.
Preparer's Daytime Telephone Number
I am fluent in English and
,
which is the same language provided in Part 3., Item Number
1.b.;
5.
Preparer's Fax Number
I have read to this sponsor every question and instruction on
this notice, as well as the answer to every question, in the
language provided in Part 3., Item Number 1.b.; and
6.
Preparer's Email Address (if any)
The sponsor has informed me that he or she understands every
instruction and question on the notice, as well as the answer to
every question, and the sponsor verified the accuracy of every
answer.
Form I-865 07/17/15 N
Page 3 of 5
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