Form I-918 - Supplement A - Petition For Qualifying Family Member Of U-1 Recipient Page 10
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12Part 9. Interpreter's Contact Information,
Preparer's Mailing Address
Certification, and Signature (continued)
3.a.
Street Number
and Name
Interpreter's Certification
3.b.
Apt.
Ste.
Flr.
I certify, under penalty of perjury, that:
3.c. City or Town
I am fluent in English and
,
which is the same language specified in Part 7., Item Number
3.d. State
3.e. ZIP Code
1.b., and Part 8. Item Number 1.b., and I have read to this
petitioner and qualifying family member in the identified
3.f.
Province
language(s) every question and instruction on this supplement
and the petitioner's and qualifying family member's answer to
3.g.
Postal Code
every question. The petitioner and qualifying family member
informed me that they understand every instruction, question,
3.h. Country
and answer on the supplement, including the Petitioner's
Declaration and Certification and the Qualifying Family
Member's Declaration and Certification, and have verified
Preparer's Contact Information
the accuracy of every answer.
4.
Preparer's Daytime Telephone Number
Interpreter's Signature
7.a.
Interpreter's Signature (sign in ink)
5.
Preparer's Mobile Telephone Number (if any)
7.b. Date of Signature (mm/dd/yyyy)
6.
Preparer's Email Address (if any)
Part 10. Contact Information, Declaration, and
Preparer's Statement
Signature of the Person Preparing this Petition, if
Other Than the Petitioner or Qualifying Family
I am not an attorney or accredited representative but
7.a.
Member
have prepared this supplement on behalf of the
petitioner and qualifying family member and with the
petitioner's and qualifying family member's consent.
Provide the following information about the preparer.
I am an attorney or accredited representative and my
7.b.
Preparer's Full Name
representation of the petitioner and qualifying family
member in this case
extends
does not extend
1.a. Preparer's Family Name (Last Name)
beyond the preparation of this supplement.
NOTE: If you are an attorney or accredited
1.b. Preparer's Given Name (First Name)
representative whose representation extends beyond
preparation of this supplement, you may be obliged to
submit a completed Form G-28, Notice of Entry of
2.
Preparer's Business or Organization Name (if any)
Appearance as Attorney or Accredited Representative,
with this supplement.
Page 10 of 12
Form I-918 Supplement A 02/07/17 N
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