Form I-907 - Request For Premium Processing Service Page 6

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Part 5. Name, Contact Information, Declaration, and Signature of the Person Preparing this Request,
If Other Than the Requestor (continued)
Preparer's Declaration
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 the 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 each and every answer
provided for each question on the request and, when required, supplied additional information to respond to a question on the request.
Preparer's Signature
8.
Preparer's Signature
Date of Signature
(mm/dd/yyyy) ►
Page 6 of 6
Form I-907 12/11/15 Y

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