Part 5. Interpreter's Contact Information,
Part 4. Applicant's or Petitioner's Statement,
Certification, and Signature
Contact Information, Certification, and Signature
(continued)
Provide the following information about the interpreter.
2.
At my request, the preparer named in Part 6.
Interpreter's Full Name
prepared this form for me based only upon
information I provided or authorized.
1.a.
Interpreter's Family Name (Last Name)
Petitioner's Contact Information
1.b.
Interpreter's Given Name (First Name)
3.
Petitioner's Daytime Telephone Number
2.
Interpreter's Business or Organization Name (if any)
4.
Petitioner's Mobile Telephone Number (if any)
Interpreter's Mailing Address
5.
Petitioner's Email Address (if any)
3.a.
Street Number
and Name
Petitioner's Certification
3.b.
Flr.
Apt.
Ste.
Copies of any documents submitted are exact photocopies of
3.c. City or Town
unaltered, original documents, and I understand that, as the
petitioner, I may be required to submit original documents to
3.d. State
3.e. ZIP Code
USCIS at a later date.
3.f.
Province
I authorize the release of any information from my records, or
from the petitioning organization's records, to USCIS or other
3.g.
Postal Code
entities and persons where necessary to determine eligibility for
the immigration benefit sought or where authorized by law. I
3.h. Country
recognize the authority of USCIS to conduct audits of this form
using publicly available open source information. I also
recognize that any supporting evidence submitted in support of
this form may be verified by USCIS through any means
Interpreter's Contact Information
determined appropriate by USCIS, including but not limited to,
4.
Interpreter's Daytime Telephone Number
on-site compliance reviews.
If filing this form on behalf of an organization, I certify that I
am authorized to do so by the organization.
5.
Interpreter's Mobile Telephone Number (if any)
I certify, under penalty of perjury, that I have reviewed this
form, I understand all of the information contained in, and
6.
Interpreter's Email Address (if any)
submitted with, my appeal or motion, and all of this information
is complete, true, and correct.
Petitioner's Signature
Interpreter's Certification
6.a.
Petitioner's Signature (sign in ink)
I certify, under penalty of perjury, that:
I am fluent in English and
,
6.b.
Date of Signature (mm/dd/yyyy)
which is the same language specified in Part 4., Item Number
1.b. in Section A or Section B, and I have read to this applicant
NOTE TO ALL APPLICANTS/PETITIONERS: If you do
or petitioner in the identified language every question and
not completely fill out this form or fail to submit required
instruction on this form and his or her answer to every question.
documents listed in the Instructions, USCIS may dismiss, deny,
The applicant or petitioner informed me that he or she
or reject your appeal or motion.
understands every instruction, question, and answer on the
form, including the Applicant's or Petitioner's Certification,
and has verified the accuracy of every answer.
Form I-290B 04/10/17 N
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