Form I-864 - Affidavit Of Support Under Section 213a Of The Act Page 5
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9Household Size
Poverty Guideline
Remarks
For
1
2
3
Year: 2 0
Y Y
USCIS
4
5
6
Use
Poverty Line:
7
8
9
Only
$
Other
Part 6. Sponsor's Income and Employment (continued)
4.
Unemployed since
Person 4
(mm/dd/yyyy) ►
9.a.
Name
5.
My current individual annual income is:
(See Instructions)
$
9.b.
Relationship
Income you are using from any other person who was
counted in your household size, including, in certain
9.c.
Current Income
$
conditions, the intending immigrant. (See Instructions.) Please
indicate name, relationship and 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
Person 1
Poverty Guidelines -- See Form I-864P.)
6.a.
Name
$
11.
The person(s) listed in 6.a., 7.a., 8.a., and 9.a. have
6.b.
Relationship
completed Form I-864A. I am filing along with this
form all necessary Forms I-864A completed by these
persons.
6.c.
Current Income
$
12.
The person(s) listed in 6.a., 7.a., 8.a., or 9.a. does not
Person 2
need to complete Form I-864A because he/she is the
intending immigrant and has no accompanying
7.a.
Name
dependents.
Name(s)
7.b.
Relationship
Federal income tax return information
7.c.
Current Income
$
13.
I have filed a Federal tax return for each of the three
Person 3
most recent tax years. I have attached the required
photocopy or transcript of my Federal tax return for
8.a.
Name
only the most recent tax year.
8.b.
Relationship
8.c.
Current Income
$
Form I-864 03/22/13 N
Page 5 of 9
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