Form I-907 - Request For Premium Processing Service Page 5

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Part 4. Interpreter's Contact Information, Certification, and Signature (continued)
Interpreter's Signature
6.
Interpreter's Signature
Date of Signature
(mm/dd/yyyy)
Part 5. Name, Contact Information, Declaration, and Signature of the Person Preparing this Request,
If Other Than the Requestor
Provide the following information about the preparer:
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)
Preparer's Mailing Address
3.
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
Province
Postal Code
Country
Preparer's Contact information
4.
Preparer's Telephone Number
5.
Preparer's Fax Number
6.
Preparer's Email Address (if any)
Preparer's Statement
7.A.
I am not an attorney or accredited representative but have prepared this request on behalf of the requestor with the requestor's
consent.
7.B.
I am an attorney or accredited representative and my representation of the requestor
in this case (choose one)
extends
does not extend beyond the preparation of this request.
Page 5 of 6
Form I-907 12/11/15 Y

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