Form I-361 - Affidavit Of Financial Support And Intent To Petition For Legal Custody Page 9
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117.
That, if the person named in item 3 is under 18 years of age, I agree to pay the interim costs incurred by that person from the
time he or she is released for immigration by his or her mother or legal guardian until I am awarded legal custody of him or her.
8.
That, if the person named in item 3 is 18 years of age or older, I agree to pay the interim costs involved in his or her travel to the
United States.
9.
That I understand that the Secretary of Homeland Security may enforce this guarantee of financial support and intent to petition
for legal custody for the person named in item 3 against me in a civil suit in the United States district court of the district in
which I reside. However, I or my estate will not be liable under this guarantee if I die or am adjudicated as bankrupt under Title
11, United States Code.
10.
That I understand that the information and documentation provided by me may be made available to the Secretary of Health and
Human Services, the Secretary of Agriculture, or the Food and Nutrition Service, who may make it available to a public
assistance agency.
11.
That I have read the instructions to this form and am aware of my responsibilities under the Social Security Act as amended, the
Food Stamp Act, and Public Law 97-359.
12.
That I am employed as or engaged in the business of
with
(Type of Business)
(Name of Concern)
at
(Street and Number)
(City)
(State)
(Zip Code)
$
A. I derived an annual income of: (if self-employed, I have
attached a copy of my last income tax return or report of
commercial rating concern, which I certify to be true and
correct to the best of my knowledge and belief.)
$
B. I have on deposit in savings banks in the United States:
$
C. I have other personal property, the reasonable value of which is:
D. I have stocks and bonds with the following market value, as
indicated on the attached list, which I certify to be true and
$
correct to the best of my knowledge and belief:
$
E. I have life insurance in the sum of:
$
With a cash surrender value of:
$
F. I own real estate valued at:
$
With mortgages or other encumbrances on it amounting to:
Which is located at
(City)
(Street and Number)
(State)
(Zip Code)
Submit This Form in Duplicate.
Form I-361 (Rev. 04/28/09)Y Page 2
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Parent category: Legal