Part 3. Requestor's Statement, Contact Information, Certification, and Signature
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
Requestor's Statement Regarding the Interpreter
Requestor's Statement Regarding the Preparer
I have requested the services of and consented to ,
is not an attorney or accredited representative, preparing this request for me.
I can read and understand English, and have read and understand every question and instruction on this request, as well
as my answer to every question.
to every question, in
The interpreter named in Part 4. has also read to me every question and instruction on this request, as well as my answer
, a language in which I am fluent.
I understand every question and instruction on this request as translated to me by my interpreter, and have provided
complete, true, and correct responses in the language indicated above.
Requestor's Signature Date of Signature (mm/dd/yyyy) 6.
I certify, under penalty of perjury, that the information in my request and any document submitted with my request were provided by
me and are complete, true, and correct.
I furthermore authorize release of information contained in this request, in supporting documents, and in my USCIS records, to other
entities and persons where necessary for the administration and enforcement of U.S. immigration laws.
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
and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.
Requestor's Daytime Telephone Number Requestor's Mobile Telephone Number (if any)
Requestor's Email Address (if any)
Requestor's Contact Information
Part 4. Interpreter's Contact Information, Certification, and Signature
Interpreter's Given Name (First Name)Interpreter's Family Name (Last Name)1.
Interpreter's Full Name
Interpreter's Business or Organization Name (if any)2.
Provide the following information concerning the interpreter.
Form I-508F 05/26/17 N Page 2 of 4