Preparer's Contact Information
Part 5. Interpreter's Contact Information,
Certification, and Signature (continued)
4.
Preparer's Daytime Telephone Number
Interpreter's Signature
5.
Preparer's Mobile Telephone Number (if any)
7.a.
Interpreter's Signature (sign in ink)
6.
Preparer's Email Address (if any)
7.b.
Date of Signature (mm/dd/yyyy)
Preparer's Statement
Part 6. Contact Information, Statement,
Certification, and Signature of the Person
I am not an attorney or accredited representative but
7.a.
have prepared this form on behalf of the applicant or
Preparing This Form, if Other Than the
petitioner and with the applicant's or petitioner's
Applicant or Petitioner
consent.
Provide the following information about the preparer.
7.b.
I am an attorney or accredited representative and
have prepared this form on behalf of the applicant or
Preparer's Full Name
petitioner and with the applicant's or petitioner's
1.a. Preparer's Family Name (Last Name)
consent.
Preparer's Certification
1.b.
Preparer's Given Name (First Name)
By my signature, I certify, under penalty of perjury, that I
prepared this form at the request of the applicant or petitioner.
2.
Preparer's Business or Organization Name (if any)
The applicant or petitioner then reviewed this completed form
and informed me that he or she understands all of the
information contained in, and submitted with, his or her form,
including the Applicant's or Petitioner's Certification, and
Preparer's Mailing Address
that all of this information is complete, true, and correct. I
completed this form based only on information that the
3.a.
Street Number
applicant or petitioner provided to me or authorized me to
and Name
obtain or use.
3.b.
Apt.
Ste.
Flr.
Preparer's Signature
3.c. City or Town
8.a. Preparer's Signature (sign in ink)
3.d. State
3.e. ZIP Code
3.f.
Province
8.b. Date of Signature (mm/dd/yyyy)
3.g.
Postal Code
3.h. Country
Form I-290B 04/10/17 N
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