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Affidavit Of Support Under Section 213A Of The Act I-864 - Official Federal Forms
| Affidavit Of Support Under Section 213A Of The Act Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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Affidavit of Support Under Section 213A of the Act Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-864 OMB No. 1615-0075 Expires 03/31/2015 For USCIS Use Only Affidavit of Support Submitter Petitioner 1st Joint Sponsor 2nd Joint Sponsor Substitute Sponsor 5% Owner Section 213A Review MEETS requirements Reviewed By: Office: Date: M M / D D DOES NOT MEET requirements Number of Support Affidavits in File 1 Remarks 2 / YYYY START HERE - Type or print in black ink. Part 1. Basis For Filing Affidavit of Support 1. am the sponsor submitting this affidavit of support because (Check only one box): 1.a. 1.b. I am the petitioner. I filed or am filing for the immigration of my relative. I filed an alien worker petition on behalf of the intending immigrant, who is related to me as my I have an ownership interest of at least 5 percent in which filed an alien worker petition on behalf of the intending immigrant, who is related to me as my Mailing Address 2.a. Street Number and Name 2.b. Apt. Ste. Flr. 2.c. City or Town 2.d. State 2.f. Postal Code 2.e. Zip Code 1.c. 2.g. Province 2.h. Country China Other Information 3. Country of Citizenship 1.d. 1.e. 1.f. I am the only joint sponsor. I am the first second of two joint sponsors. China 4. 5. Date of Birth (mm/dd/yyyy) The original petitioner is deceased. I am the substitute sponsor. I am the intending immigrant's Alien Registration Number (A-Number) NOTE: If you check box 1.b., 1.c., 1.d., 1.e., or 1.f., you must include proof of your citizen, national, or lawful permanent resident status. A- Part 2. Information on the Principal Immigrant 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name Form I-864 03/22/13 N American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 9 Part 3. Information on the Immigrant(s) You Are Sponsoring 1. I am sponsoring the principal immigrant named in Part 2. Yes 2. No (Applicable only in cases with two joint sponsors) Family Member 3 4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name 4.d. Relationship to Sponsored Immigrant I am sponsoring the following family members immigrating at the same time or within 6 months of the principal immigrant named in Part 2. Do not include any relative listed on a separate visa petition. Family Member 1 2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name 2.d. Relationship to Sponsored Immigrant 4.e. Date of Birth 4.f. (mm/dd/yyyy) Alien Registration Number (A-Number) A- 2.e. Date of Birth 2.f. (mm/dd/yyyy) Family Member 4 5.a. Family Name (Last Name) 5.b. Given Name (First Name) 5.c. Middle Name 5.d. Relationship to Sponsored Immigrant Alien Registration Number (A-Number) A- Family Member 2 3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name 3.d. Relationship to Sponsored Immigrant 5.e. Date of Birth 5.f. (mm/dd/yyyy) Alien Registration Number (A-Number) A- 3.e. Date of Birth 3.f. (mm/dd/yyyy) Family Member 5 6.a. Family Name (Last Name) 6.b. Given Name (First Name) 6.c. Middle Name Alien Registration Number (A-Number) A- Form I-864 03/22/13 N American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 9 For USCIS Use Only Part 3. Information on the Immigrant(s) You Are Sponsoring (continued) Family Member 5 (Continued) 6.d. Relationship to Sponsored Immigrant 7. 6.e. Date of Birth 6.f. (mm/dd/yyyy) Enter the total number of immigrants you are sponsoring on this form from Items 1 through 6. Alien Registration Number (A-Number) A- Part 4. Information on the Sponsor Sponsor's Full Name 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name Sponsor's Place of Residence 3.a. Street Number and Name 3.b. Apt. Ste. Flr. 3.c. City or Town 3.d. State 3.f. Flr. Postal Code 3.e. Zip Code Sponsor's Mailing Address 2.a. Street Number and Name 2.b. Apt. Ste. 3.g. Province 3.h. Country 2.c. City or Town 2.d. State 2.f. Postal Code 2.e. Zip Code China Other Information 4. Telephone Number Country of Domicile ( ) - 2.g. Province 5. 2.h. Country China 6. Chile Date of Birth (mm/dd/yyyy) Form I-864 03/22/13 N American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 9 For USCIS Use Only Part 4. Information on the Sponsor (continued) 7. City or Town of Birth Citizenship/Residency 11.a. 8. State or Province of Birth 11.b. 11.c. 9. Country of Birth I am a U.S. citizen. I am a U.S. national (for joint sponsors only). I am a lawful permanent resident. My alien registration number is: China 10. U.S. Social Security Number (Required) AMilitary Service (To be completed by petitioner sponsors only.) 12. I am currently on active duty in the U.S. armed services. Yes No Part 5. Sponsor's Household Size Your Household Size - DO NOT COUNT ANYONE TWICE Persons you are sponsoring in this affidavit: 6. 1. Enter the number you entered on line 7 of Part 3. 7. Persons NOT sponsored in this affidavit: 2. 3. 4. Yourself. If you are currently married, enter "1" for your spouse. If you have dependent children, enter the number here. 8. 1 5. If you have any other dependents, enter the number here. If you have sponsored any other persons on an I-864 or I-864 EZ who are now lawful permanent residents, enter the number here. OPTIONAL: If you have siblings, parents, or adult children with the same principal residence who are combining their income with yours by submitting Form I-864A, enter the number here. Add together lines 1-7 and enter the number here. Household Size: Part 6. Sponsor's Income and Employment I am currently: 1. Employed as a/an 3. 1.a. Name of Employer #1 (if applicable) 3.a. Retired from: Company Name 2. Self-employed as a/an 1.b. Name of Employer #2 (if applicable) 3.b. Date of Retirement (mm/dd/yyyy) Form I-864 03/22/13 N American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 9 For USCIS Use Only Household Size 2 1 3 4 5 7 8 Other 6 9 Poverty Guideline Year: 2 0 Y Y Poverty Line: $ Remarks Part 6. Sponsor's Income and Employment (continued) 4. Unemployed since (mm/dd/yyyy) My current individual annual income is: (See Instructions) $ Person 4 9.a. Name 5. 9.b. Relationship Income you are using from any other person who was counted in your household size, including, in certain conditions, the intending immigrant. (See Instructions.) Please indicate name, relationship and income. Person 1 6.a. Name 9.c. Current Income 10. $ My current Annual Household Income (Total all lines from 5, 6.c., 7.c., 8.c., and 9.c. Will be Compared to Poverty Guidelines -- See Form I-864
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