Form I-485 Supplement J 07/15/19
Page 2 of 7
Select all applicable boxes.
Part 3. Applicant's Statement, Contact
Information, Certification, and Signature
NOTE: Read the Penalties section of the Supplement J
Instructions before completing this part. You must file
Supplement J while in the United States.
At my request, the preparer named in Part 4.,
I can read and understand English, and I have read
and understand every question and instruction on this
supplement and my answer to every question.
prepared this supplement for me based only upon
information I provided or authorized.
Applicant's Daytime Telephone Number3.
Applicant's Contact Information
Applicant's Mobile Telephone Number (if any)4.
Applicant's Email Address (if any)5.
Copies of any documents I have submitted are exact
photocopies of unaltered, original documents, and I understand
that USCIS may require that I submit original documents to
USCIS at a later date. Furthermore, I authorize the release of
any information from any of my records that USCIS may need
to determine my eligibility for the immigration benefit I seek.
I further authorize release of information contained in this
supplement, in supporting documents, and in my USCIS records
to other entities and persons when necessary for the
administration and enforcement of U.S. immigration laws.
I certify, under penalty of perjury, that I provided or authorized
all of the information in my supplement, especially in Part 1.
and Part 2., I understand all of the information contained in,
and submitted with my supplement, and that all of this
information is complete, true, and correct.
I further declare, under penalty of perjury, that I have reviewed
the job offer described in Part 6. of this supplement, and I
intend to accept the position offered in Part 6. of this
supplement upon approval of my Form I-485.
Date of Signature (mm/dd/yyyy)6.b.
Applicant's Signature (sign in ink)6.a.
Part 4. Contact Information, Declaration, and
Signature of the Person Preparing This
Supplement, if Other Than the Applicant
Provide the following information about the preparer.
Preparer's Full Name
Preparer's Given Name (First Name)1.b.
Preparer's Family Name (Last Name)1.a.
Preparer's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.b. Apt. Flr.Ste.
Preparer's Business or Organization Name (if any)
Preparer's Contact Information
Preparer's Daytime Telephone Number4.
Preparer's Email Address (if any)6.
Preparer's Mobile Telephone Number (if any)5.