Form I-864ez - Affidavit Of Support Under Section 213a Of The Act Page 5
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7Part 7. Interpreter's Contact Information,
Part 6. Sponsor's Contract, Statement, Contact
Certification, and Signature
Information, Certification, and Signature
(continued)
Provide the following information about the interpreter.
A.
I know the contents of this affidavit of support that I
Interpreter's Full Name
signed;
B.
I have read and I understand each of the obligations
1.a.
Interpreter's Family Name (Last Name)
described in Part 6., and I agree, freely and without
any mental reservation or purpose of evasion, to
accept each of those obligations in order to make it
1.b.
Interpreter's Given Name (First Name)
possible for the immigrant indicated in Part 2. to
become a lawful permanent resident of the United
States;
2.
Interpreter's Business or Organization Name (if any)
C.
I agree to submit to the personal jurisdiction of any
Federal or state court that has subject matter
jurisdiction of a lawsuit against me to enforce my
Interpreter's Mailing Address
obligations under this Form I-864EZ;
3.a.
Street Number
D.
Each of the Federal income tax returns submitted in
and Name
support of this affidavit are true copies, or are
3.b.
Apt.
Ste.
Flr.
unaltered tax transcripts, of the tax returns I filed
with the IRS;
3.c. City or Town
E.
I understand that, if I am related to the sponsored
immigrant by marriage, the termination of the
3.d. State
3.e. ZIP Code
marriage (by divorce, dissolution, annulment, or
other legal process) will not relieve me of my
3.f.
Province
obligations under this Form I-864EZ; and
3.g.
Postal Code
F.
I authorize the Social Security Administration to
release information about me in its records to the
3.h.
Country
Department of State and USCIS.
Sponsor's Signature
Interpreter's Contact Information
6.a. Sponsor's Signature
4.
Interpreter's Daytime Telephone Number
6.b.
Date of Signature
(mm/dd/yyyy)
5.
Interpreter's Email Address (if any)
NOTE TO ALL SPONSORS: If you do not completely fill
out this affidavit or fail to submit required documents listed in
the Instructions, USCIS or the Department of State may deny
Interpreter's Certification
your request.
I certify that:
I am fluent in English and
,
which is the same language provided in Part 6., Item Number
1.b.;
I have read to this sponsor every question and instruction on
this affidavit, as well as the answer to every question, in the
language provided in Part 6., Item Number 1.b.; and
Form I-864EZ 07/02/15 N
Page 5 of 7
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