Form I-361 - Affidavit Of Financial Support And Intent To Petition For Legal Custody For Public Law 97-359 Amerasian Page 4
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8Part 3. Other Information (continued)
17.e.
Date of Filing (mm/dd/yyyy)
14.a. Family Name
17.f.
Relationship
(Last Name)
14.b. Given Name
(First Name)
18.
Have you ever submitted or are you submitting visa
14.c. Middle Name
petitions to USCIS for any other beneficiaries?
Yes
No
14.d. Date of Birth (mm/dd/yyyy)
If you answered "Yes" to Item Number 18., provide the
14.e.
A-Number (if any)
responses to Item Numbers 19.a. - 19.f. for each previous
►
A-
beneficiary. If you need to provide information for more than
one beneficiary, use the space provided in Part 8. Additional
14.f.
This person is:
Information.
Wholly Dependent
Partially Dependent
19.a.
A-Number (if any)
14.g. Relationship
►
A-
19.b. Family Name
(Last Name)
19.c. Given Name
15.a. Family Name
(First Name)
(Last Name)
19.d. Middle Name
15.b. Given Name
(First Name)
19.e.
Date of Filing (mm/dd/yyyy)
15.c. Middle Name
19.f.
Relationship
15.d. Date of Birth (mm/dd/yyyy)
15.e.
A-Number (if any)
►
A-
Part 4. Sponsor's Statement, Contact
Information, Certification, and Signature
15.f.
This person is:
Wholly Dependent
Partially Dependent
NOTE: Read the information on penalties in the Penalties
section of the Form I-361 Instructions before completing this
15.g. Relationship
part.
Sponsor's Statement
16.
Have you ever submitted or are you submitting affidavits
of support for any other beneficiaries?
NOTE: Select the box for either Item Number 1.a. or 1.b.
Yes
No
If applicable, select the box for Item Number 2.
If you answered "Yes" to Item Number 16., provide the
I can read and understand English, and have read and
1.a.
responses to Item Numbers 17.a. - 17.f. for each previous
understand every question and instruction on this
beneficiary. If you need to provide information for more than
affidavit, as well as my answer to every question.
one beneficiary, use the space provided in Part 8. Additional
Information.
1.b.
The interpreter named in Part 5. has also read to me
every question and instruction on this affidavit, as well
17.a.
A-Number (if any)
as my answer to every question, in
►
A-
,
17.b. Family Name
a language in which I am fluent. I understand every
(Last Name)
question and instruction on this affidavit as translated
17.c. Given Name
to me by my interpreter, and have provided complete,
(First Name)
true, and correct responses in the language indicated
above.
17.d. Middle Name
Form I-361 09/11/15 N
Page 4 of 8
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Parent category: Legal