I-864 (Affidavit Of Support) Questionnaire Form (Page 2 of 2) in pdf

I-864 (Affidavit Of Support) Questionnaire Form Page 2

I-864 (Affidavit of Support) Questionnaire

Job Title(s) ________________________________________________________________

Self-employed Occupation ___________________________________________________

Date of Retirement ___/___/___ (dd/mm/yyyy)

Retirement from (Company Name) ____________________________________________

If unemployed, date unemployment commenced ___/___/___ (dd/mm/yyyy)

Current Individual Annual Income $___________________________

Current Annual Household Income $__________________________

Have you filed a Federal income tax return for each of the most recent tax years? ______

Total income (adjusted gross income as reported on Federal income tax returns) for most

recent three years -

Tax Year ________ Total Income $__________________

Tax Year ________ Total Income $ __________________

IF USING YOUR ASSETS TO SUPPLEMENT YOUR INCOME, PLEASE COMPLETE THE

FOLLOWING

Balance of all savings and checking accounts $_________________________________

Net cash value of real-estate holdings (current assessed value minus mortgage debt)

$____________________________________

Net cash value of all stocks, bonds, certificates of deposit and any other assets not already

included $_______________________________________________________________

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I-864 (Affidavit Of Support) Questionnaire Form Page 2