Form N-300 - Application To File Declaration Of Intention Page 4
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Part 3. Interpreter's Contact Information, Certification, and Signature
(continued)
Interpreter's Contact Information
4.
Interpreter's Daytime Telephone Number
5. Interpreter's Mobile Telephone Number (if any)
6.
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 provided in Part 2.,
Item B., in Item Number 1.; and I have read to this applicant in the identified language every question and instruction on this
application and his or her answer to every question. The applicant informed me that he or she understands every instruction, question,
and answer on the application, including the Applicant's Certification, and has verified the accuracy of every answer.
Interpreter's Signature
7.
Interpreter's Signature
Date of Signature (mm/dd/yyyy)
Part 4. Contact Information, Declaration, and Signature of the Person Who Prepared This Application,
if Other Than the Applicant
Provide the following information about the preparer.
Preparer's Full Name
1.
Preparer's Family Name (Last Name)
Preparer's Given Name (First Name)
2.
Preparer's Business or Organization Name (if any)
Preparer's Mailing Address
3.
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
Province
Postal Code
Country
Form N-300 12/23/16 N
Page 4 of 8
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