Form I-824 - Application For Action On An Approved Application Or Petition Page 3
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3Part 4. Signature
(
Read the information on penalties in the instructions before completing this part.)
I certify, under penalty of perjury under the laws of the United States of America, that this information and the evidence submitted
with it is all true and correct. I authorize the release of any information from my records that the U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit sought.
Signature
Daytime Phone Number (With area code)
Date (mm/dd/yyyy)
NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be
found eligible for the requested benefit and this application may be denied.
Part 5. Signature of Person Preparing Form, if Other than Above
(Sign below)
I declare that I prepared this at the request of the applicant and it is based on all information of which I have knowledge.
Print or Type Your Name
Signature
Firm Name and Address
Daytime Phone Number (With area code)
Date (mm/dd/yyyy)
E-Mail Address (If any)
Form I-824 (Rev. 11/23/10) Y Page 3
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Parent category: Legal