Form I-864 - Affidavit Of Support Under Section 213a Of The Act
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9Affidavit of Support Under Section 213A of the Act
USCIS
Department of Homeland Security
Form I-864
U.S. Citizenship and Immigration Services
OMB No. 1615-0075
Expires 03/31/2015
Affidavit of Support Submitter
Section 213A Review
Number of Support Affidavits in File
Petitioner
MEETS
DOES NOT MEET
1
2
For
requirements
requirements
1st Joint Sponsor
USCIS
Remarks
Use
2nd Joint Sponsor
Reviewed By:
Only
Substitute Sponsor
Office:
5% Owner
/
/
M M
D D
Y Y Y Y
Date:
►
START HERE - Type or print in black ink.
Part 1. Basis For Filing Affidavit of Support
Mailing Address
2.a.
Street Number
1.
and Name
am the sponsor submitting this affidavit of support because
2.b. Apt.
Ste.
Flr.
(Check only one box):
I am the petitioner. I filed or am filing for the
1.a.
2.c. City or Town
immigration of my relative.
2.d. State
2.e. Zip Code
I filed an alien worker petition on behalf of the
1.b.
intending immigrant, who is related to me as my
2.f.
Postal Code
1.c.
I have an ownership interest of at least 5 percent in
2.g.
Province
2.h.
Country
which filed an alien worker petition on behalf of the
intending immigrant, who is related to me as my
Other Information
3.
Country of Citizenship
1.d.
I am the only joint sponsor.
1.e.
I am the
first
second of two joint sponsors.
►
4.
Date of Birth
(mm/dd/yyyy)
The original petitioner is deceased. I am the
1.f.
substitute sponsor. I am the intending immigrant's
5.
Alien Registration Number (A-Number)
►
A-
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.
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
Page 1 of 9
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