Form I-601 - Application For Waiver Of Grounds Of Inadmissibility - U.s. Citizenship And Immigration Services Page 9

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Part 8. Interpreter's Contact Information,
Preparer's Statement
Certification, and Signature (continued)
I am not an attorney or accredited representative but
7.a.
have prepared this application on behalf of the
Interpreter's Signature
applicant and with the applicant's consent.
7.a.
Interpreter's Signature (sign in ink)
7.b.
I am an attorney or accredited representative and my
representation of the applicant in this case
extends
does not extend beyond the
preparation of this application.
7.b.
Date of Signature (mm/dd/yyyy)
NOTE: If you are an attorney or accredited
representative, you may be obliged to submit a
Part 9. Contact Information, Declaration, and
completed Form G-28, Notice of Entry of Appearance
Signature of the Person Preparing this
as Attorney or Accredited Representative, or G-28I,
Notice of Entry of Appearance as Attorney in Matters
Application, if Other Than the Applicant
Outside the Geographical Confines of the United
Provide the following information about the preparer.
States, with this application.
Preparer's Full Name
Preparer's Certification
1.a. Preparer's Family Name (Last Name)
By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant. The
applicant then reviewed this completed application and
1.b.
Preparer's Given Name (First Name)
informed me that he or she understands all of the information
contained in, and submitted with, his or her application,
including the Applicant's Declaration and Certification, and
2.
Preparer's Business or Organization Name (if any)
that all of this information is complete, true, and correct. I
completed this application based only on information that the
applicant provided to me or authorized me to obtain or use.
Preparer's Mailing Address
Preparer's Signature
3.a.
Street Number
8.a. Preparer's Signature (sign in ink)
and Name
3.b.
Apt.
Ste.
Flr.
8.b. Date of Signature (mm/dd/yyyy)
3.c. City or Town
3.d. State
3.e. ZIP Code
3.f.
Province
3.g. Postal Code
3.h.
Country
Preparer's Contact Information
4.
Preparer's Daytime Telephone Number
5.
Preparer's Mobile Telephone Number (if any)
6.
Preparer's Email Address (if any)
Form I-601 08/21/17 N
Page 9 of 12

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