Form I-361 - Affidavit Of Financial Support And Intent To Petition For Legal Custody Page 8
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11OMB No. 1615-0021; Expires 04/30/2012
I -361, Affidavit of Financial Support and Intent to
Department of Homeland Security
Petition for Legal Custody of P.L. 97-359 Amerasian
U. S. Citizenship and Immigration Services
NOTE: Use only to sponsor a Public Law 97-359 Amerasian. (Answer all items. Type or print legibly in black ink.)
I,
residing at
(Street and number)
(Name)
(Country)
(City)
(State)
(Zip Code if in U.S.)
Being Duly Sworn Depose and Say:
1. That I was born on
at
(Date)
(City)
(Country)
If you are not a native born U.S. citizen, answer the following as appropriate:
A. If a U.S. citizen through naturalization, give certificate of naturalization number:
B. If a U.S. citizen through parent(s) or marriage, give citizenship certificate number:
C. If U.S. citizenship was derived by some other method, attach an explanation.
D. If a lawfully admitted permanent resident of the United States, give A-Number: A
2.
That I am
years of age and have resided in the United States since (date):
3.
That this affidavit is executed on behalf of the following person:
Name
Gender
Date of Birth (mm/dd/yyyy)
Born in (Country)
Alien Registration Number
Marital Status
Relationship to Deponent
Presently Resides at:
(Street and Number)
(City)
(State)
(Country)
4.
That this affidavit is made by me to assure the U.S. Government that the person named in item 3 will not become a public
charge in the United States.
5.
That I am willing and able to receive, maintain, and support the person named in item 3, and that I agree to furnish financial
support during the entire five-year period beginning on the date the named person acquires the status of an alien lawfully
admitted for permanent residence and ending on the date on which the named person becomes 21 years of age, whichever period
is longer. The financial support that I furnish must be sufficient to maintain my family, including the named person, in the
United States, at a level equal to at least 125 percent of the current official poverty line (as established by the Director of the
Office of Management and Budget, under Section 673(2) of the Omnibus Budget Reconciliation Act of 1981 and as revised by
the Secretary of Health and Human and Services under section 652 of that Act) for a family the size of my family, including the
named person.
6.
That, if the person named in item 3 is under 18 years of age, I agree to petition the court having jurisdiction within 30 days of
the named person's arrival in the United States to be awarded legal custody according to the laws of the State where he or she
will reside until he or she is 18 years of age.
Submit This Form in Duplicate.
Form I-361 (Rev. 04/28/09)Y
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