(explain) Name of Representative for Employer/Organization Name of Employer/Organization and Address (USPS ZIP Code Lookup) Beneficiary's Full Name Other Names Used (if any) Beneficiary's Current CNMI Address American LegalNet, Inc. www.FormsWorkFlow.com Beneficiary's Foreign Address Petitioner's or Authorized Signatory's Statement Petitioner's or Authorized Signatory's Contact Information Petitioner's or Authorized Signatory's Declaration and Certification Petitioner's or Authorized Signatory's Signature Interpreter's Full Name Interpreter's Mailing Address Interpreter's Contact Information Interpreter's Certification Interpreter's Signature Preparer's Full Name Preparer's Mailing Address Preparer's Contact Information Preparer's Statement Preparer's Certification Preparer's Signature Employer/Organization's Physical Address Employer/Organization's Contact Information Petitioner's Signature Employer/Organization's Physical Address Employer/Organization's Contact Information Petitioner's Signature