Form Eoir-42b - Application For Cancellation Of Removal And Adjustment Of Status For Certain Nonpermanent Residents Page 13

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PART 9 - SIGNATURE
APPLICATION NOT TO BE SIGNED BELOW UNTIL APPLICANT APPEARS BEFORE
AN IMMIGRATION JUDGE
I swear or affirm that I know the contents of this application that I am signing, including the attached documents and supplements, and that they
are all true to the best of my knowledge, taking into account the correction(s) numbered
to
, if any, that were made by me or at
my request.
(Signature of Applicant or Parent or Guardian)
Subscribed and sworn to before me by the above-named applicant at
Immigration Judge
Date (Month, Day, Year)
PART 10 - PROOF OF SERVICE
J
J
I hereby certify that a copy of the foregoing Form EOIR-42B was:
- delivered in person
- mailed first class, postage prepaid
on
to the Assistant Chief Counsel for the DHS (U.S. Immigration and Customs Enforcement - ICE)
(Month, Day, Year)
at
(Number and Street, City, State, Zip Code)
Signature of Applicant (or Attorney or Representative)
Please continue answers on a separate sheet as needed.
Form EOIR-42B
Revised July 2014
(8)

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