Uscis Form I-407 - Record Of Abandonment Of Lawful Permanent Resident Status Page 2
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1
2The alien has informed me that he or she understands each and
Part 1. Information About the Alien (continued)
every instruction and question on the form, as well as the
answer to each and every question.
For Consent of Parents, Custodial Parents, or Legal
Guardian to Submit Form I-407 for Minors 17 Years
1.a. Signature of Interpreter (if applicable) (sign in ink)
of Age or Younger
As the parents or guardian of the alien minor who is identified
1.b. Full Name of Interpreter
in Part 1. of this form, I/we consent to the alien minor's
submission of this form.
1.c.
Date of Signature (mm/dd/yyyy)
14.a. Signature of Parents, Custodial Parents, or Legal Guardian
(sign in ink)
Part 3. For Government Use Only
Instructions to officer: Select Item Number 1. if you
interviewed the alien. If you did not, select Item Number 2.
14.b.
Name of Parents, Custodial Parents, or Legal Guardian
and state the basis for your conclusion that the alien may have
abandoned lawful permanent resident status. Sign the form and
provide other information requested.
1.
I certify that I personally interviewed the alien who is
identified in Part 1., who has signed this Form I-407,
14.c.
Date of Signature (mm/dd/yyyy)
and that I advised the alien of the hearing rights
specified in the Instructions. The alien stated he or
If signed by only one parent, custodian, or legal guardian,
she fully understands the effect of signing this Form
indicate evidence to show sole parental, custodial, or legal
I-407. I further certify that, if an interpreter was
guardianship responsibility.
used, I confirmed that the alien understood the
14.d.
Check all that apply:
interpreter.
2.
I certify that I was not able to interview the alien who
Death of other parent
is identified in Part 1. of this Form I-407. My basis
for concluding that the alien may have abandoned
Termination of other parent's rights
lawful permanent resident status is:
Award of sole legal custody
Appointment as guardian
3.
A copy of the signed Form I-407 was provided to the alien.
Yes
No
Part 2. Certification and Signature of the
DHS/Consular Officer Information
Interpreter
4.a.
Name of DHS/Consular Officer
Interpreter Certification
I certify that:
4.b. Signature of DHS/Consular Officer (sign in ink)
I am fluent in English and
(write the other language in the box provided above).
4.c.
Title of DHS/Consular Officer
I further certify that I have read each and every question and
instruction on this form, as well as the answer to each and every
question on this form, in the language provided above; and
4.d. Name of DHS Component, if signed by a DHS officer
4.e. Date of Signature (mm/dd/yyyy)
Form I-407 03/31/17 Y
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