bout providing court dispositions. Form I-765 12/26/19 Page 3 of? EFTA01699769 art 3. Applicant's Statement, Contact !Information, Declaration, Certificationvand! Signature NOTE: Readthetenaltiessection.d.the Forin 1-766 Instructions before compledirgibi.s section. You mustae Form I-765 while in the United