Fillable Form I-912 - Request For Fee Waiver (Page 8 of 11) in pdf

Form I-912 - Request For Fee Waiver Page 8

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Part 9. Interpreter's Contact Information, Certification, and Signature

Did any person filing this request use an interpreter?

Yes, (complete this section)

No (skip to Part 10.)

Was the same interpreter used for all individuals requesting a fee waiver (as listed in Part 3.)?

Yes

NOTE for Family Members: If you used a different interpreter than the one used by the requestor, make additional copies of Part 9.,

provide the following information, indicate the family member for whom he or she interpreted, and include the pages with your

completed Form I-912.

Provide the following information about the interpreter for

Interpreter's Full Name

Interpreter's Family Name (Last Name)

Interpreter's Given Name (First Name)

Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address

Street Number and Name

Apt.

Ste.

Flr.

Number

City or Town

State

ZIP Code

Province

Postal Code

Country

Interpreter's Contact Information

Interpreter's Daytime Telephone Number

Interpreter's Mobile Telephone Number (if any)

Interpreter's Email Address (if any)

Interpreter's Certification

I certify, under penalty of perjury, that:

I am fluent in English and

, which is the same language specified

in Part 7., Item B. in Item Number 1., and I have read to this requestor in the identified language every question and instruction on

this request and his or her answer to every question. The requestor informed me that he or she understands every instruction, question,

and answer on the request, including the Applicant's Certification, and has verified the accuracy of every answer.

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

Form I-912 04/25/16 Y

Page 8 of 11

Form I-912 - Request For Fee Waiver Page 8

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