Part E. Declaration of Person Preparing Form, if Other Than Applicant, Spouse, Parent, or Child

I declare that I have prepared this application at the request of the person named in Part I,

that the responses provided are based on all information of which I have knowledge, or which

was provided to me by the applicant, and that the completed application was read to the

applicant in his or her native language or a language he or she understands for verification

before he or she signed the application in my presence. I am aware that the knowing placement

of false information on the Form 1-589 may also subject me to civil penalties under

8 U.S.C. 1324c and/or criminal penalties under 18 U.S.C. 1546(a).

Signature of Preparer

Print Complete Name of Preparer

Daytime Telephone Number

Address of Preparer:

Street Number and Name

Apt. Number

City

State

Zip Code

To be completed by an attorney or accredited representative (if any).

Select this box if Form G-28 is attached.

Attorney State Bar Number (if applicable)

Attorney or Accredited Representative

USCIS Online Account Number (if any)

Assistant