H-2B Returning Worker Certification As a supplement to the certification made on the attached Form I-129, Petition for a Nonimmigrant Worker, I further certify that the workers listed below have been issued an H-2B visa or changed to H-2B status during one of the last three (3) fiscal years. (Attach a separate sheet if additional space is needed.) Given (First) Name of Each Returning Worker Family (Last) Name Date of Birth Date of Last H2B Admission or Change to H-2B Status (if known) I certify, under penalty of perjury under the laws of the United States of America, that the information included in this certification is all true and correct. ________________________________________________ Signature ________________________________________________ Date Note: This certification must be signed by the same person who signed Part 7 of Form I-129. American LegalNet, Inc. www.FormsWorkFlow.com