Form I-363 - Request To Enforce Affidavit Of Financial Support And Intent To Petition For Legal Custody For Public Law 97-359 Amerasian Page 5
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7Preparer's Contact Information
Part 5. Interpreter's Contact Information,
Certification, and Signature (continued)
4.
Preparer's Daytime Telephone Number
Interpreter's Certification
5.
Preparer's Mobile Telephone Number (if any)
I certify, under penalty of perjury, that:
I am fluent in English and
,
which is the same language specified in Part 4., Item Number
6.
Preparer's Email Address (if any)
1.b., and I have read to this applicant in the identified language
every question and instruction on this request and his or her
answer to every question. The applicant informed me that he or
Preparer's Statement
she understands every instruction, question, and answer on the
request, including the Applicant's Certification, and has
I am not an attorney or accredited representative
7.a.
verified the accuracy of every answer.
but have prepared this application on behalf of
the applicant and with the applicant's consent.
Interpreter's Signature
I am an attorney or accredited representative and
7.b.
my representation of the applicant in this case
7.a.
Interpreter's Signature (sign in ink)
does not extend beyond the
extends
preparation of this application.
7.b.
Date of Signature (mm/dd/yyyy)
NOTE: If you are an attorney or accredited
representative whose representation extends
beyond preparation of this application, you may
Part 6. Contact Information, Declaration, and
be obliged to submit a completed Form G-28,
Signature of the Person Preparing this
Notice of Entry of Appearance as Attorney or
Accredited Representative, with this request.
Application, if Other Than the Applicant
Provide the following information about the preparer.
Preparer's Certification
Preparer's Full Name
By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant. The
1.a. Preparer's Family Name (Last Name)
applicant then reviewed this completed request and informed
me that he or she understands all of the information contained
in, and submitted with, his or her request, including the
1.b.
Preparer's Given Name (First Name)
Applicant's Certification, and that all of this information is
complete, true, and correct. I completed this request based only
on information that the applicant provided to me or authorized
2.
Preparer's Business or Organization Name
me to obtain or use.
Preparer's Signature
Preparer's Mailing Address
8.a. Preparer's Signature (sign in ink)
3.a.
Street Number
and Name
3.b. Apt.
8.b. Date of Signature (mm/dd/yyyy)
Ste.
Flr.
3.c. City or Town
3.d. State
3.e. ZIP Code
3.f.
Province
3.g. Postal Code
3.h. Country
Form I-363 03/01/17 N
Page 5 of 7
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Parent category: Legal