Part 7: Preparer's Info
If no preparer assisted with this petition, just leave the form blank and click on "submit"
Preparer's Full Name
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Please enter the preparer's family name.
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Please enter the preparer's given name.
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Please enter a valid organization name or leave blank.
Preparer's Mailing Address
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Please enter a street address.
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Please select a unit type.
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Please enter the unit number.
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Please enter a city.
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Please select a state.
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Please enter a province or leave blank.
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Please enter a postal code or leave blank.
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Please enter a country.
Preparer's Contact Information
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Please enter a valid phone number.
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Please enter a valid mobile number or leave blank.
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Please enter a valid email or leave blank.
Preparer's Statement
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Please select a preparer status.
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Please select the representation scope.
NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this application, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application.
Preparer Sign Below
NOTE: Use your finger or mouse to draw your signature.
Leave it blank if you prefer to sign the PDF on paper or digitally later.
Leave it blank if you prefer to sign the PDF on paper or digitally later.