Fillable Form I-134 - Affidavit Of Support (Page 5 of 8) in pdf

I understand that USCIS may require me to appear for an

Part 4. Sponsor's Statement, Contact

appointment to take my biometrics (fingerprints, photograph,

Information, Certification, and Signature

and/or signature) and, at that time, if I am required to provide

NOTE: Read the Penalties section of the Form I-134

biometrics, I will be required to sign an oath reaffirming that:

Instructions before completing this part.

1) I reviewed and provided or authorized all of the

information in my affidavit;

Sponsor's Statement

2) I understood all of the information contained in, and

NOTE: Select the box for either Item Number 1.a. or 1.b.

submitted with, my affidavit; and

If applicable, select the box for Item Number 2.

3) All of this information was complete, true, and correct at

I can read and understand English, and I have read and

1.a.

the time of filing.

understand every question and instruction on this

I certify, under penalty of perjury, that I provided or authorized

affidavit and my answer to every question.

all of the information in my affidavit, I understand all of the

1.b.

The interpreter named in Part 5. read to me every

information contained in, and submitted with, my affidavit, and

question and instruction on this affidavit and my

that all of this information is complete, true, and correct.

answer to every question in

That this affidavit is made by me to assure the U.S. Government

that the person named in Part 2. will not become a public

charge in the United States.

a language in which I am fluent and I understood

everything.

That I am willing and able to receive, maintain, and support the

At my request, the preparer named in Part 6.,

person named in Part 2. I am ready and willing to deposit a

bond, if necessary, to guarantee that such persons will not

become a public charge during his or her stay in the United

prepared this affidavit for me based only upon

States, or to guarantee that the above named persons will

information I provided or authorized.

maintain his or her nonimmigrant status, if admitted

temporarily, and will depart prior to the expiration of his or her

Sponsor's Contact Information

authorized stay in the United States.

Sponsor's Daytime Telephone Number

That I understand that Form I-134 is an "undertaking" under

section 213 of the Immigration and Nationality Act, and I may

be sued if the persons named in Part 2. become a public charge

Sponsor's Mobile Telephone Number (if any)

after admission to the United States.

That I understand that Form I-134 may be made available to any

Federal, State, or local agency that may receive an application

Sponsor's Email Address (if any)

from the persons named in Part 2. for Food Stamps,

Supplemental Security Income, or Temporary Assistance to

Needy Families.

Sponsor's Certification

That I understand that if the person named in Part 2. does apply

for Food Stamps, Supplemental Security Income, or Temporary

Copies of any documents I have submitted are exact photocopies

Assistance for Needy Families, my own income and assets may

of unaltered, original documents, and I understand that USCIS or

be considered in deciding the person's application. How long

the Department of State may require that I submit original

my income and assets may be attributed to the persons named in

documents to USCIS or the Department of State at a later date.

Part 2. is determined under the statutes and rules governing

Furthermore, I authorize the release of any information from any

each specific program.

of my records that USCIS or the Department of State may need

to determine my eligibility for the immigration benefit I seek.

I acknowledge that I have read the section entitled Sponsor and

Beneficiary Liability in the Instructions for this affidavit, and am

I further authorize release of information contained in this

aware of my responsibilities as a sponsor under the Social

affidavit, in supporting documents, and in my USCIS or the

Security Act, as amended, and the Food Stamp Act, as amended.

Department of State records to other entities and persons where

necessary for the administration and enforcement of U.S.

Sponsor's Signature

immigration laws.

6.a.

Sponsor's Signature

6.b. Date of Signature (mm/dd/yyyy)

Form I-134 11/30/16 N

Page 5 of 8

Form I-134 - Affidavit Of Support Page 5

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