Uscis I-864 Real Estate Consulting Agreement Page 4
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USCIS
Use
Only
Part 5. Sponsor's Household Size
Part 4. Information About You (Sponsor)
(continued)
NOTE: Do not count any member of your household more
than once.
Other Information
Persons you are sponsoring in this affidavit:
5.
Country of Domicile
Provide the number you entered in Part 3., Item Number
1.
28.
6.
Date of Birth (mm/dd/yyyy)
Persons NOT sponsored in this affidavit:
7.
City or Town of Birth
2.
Yourself.
3.
If you are currently married, enter "1" for your spouse.
8.
State or Province of Birth
4.
If you have dependent children, enter the number here.
9.
Country of Birth
5.
If you have any other dependents, enter the number here.
10.
U.S. Social Security Number (Required)
►
6.
If you have sponsored any other persons on Form I-864
or Form I-864 EZ who are now lawful permanent
Citizenship or Residency
residents, enter the number here.
11.a.
I am a U.S. citizen.
7.
OPTIONAL: If you have siblings, parents, or adult
11.b.
I am a U.S. national.
children with the same principal residence who are
11.c.
I am a lawful permanent resident.
combining their income with yours by submitting Form
I-864A, enter the number here.
12.
Sponsor's A-Number (if any)
►
A-
8.
Add together Part 5., Item Numbers 1. - 7. and enter the
number here.
Household Size:
13.
Sponsor's USCIS ELIS Account Number (if any)
►
Military Service (To be completed by petitioner sponsors only.)
14.
I am currently on active duty in the U.S. Armed Forces
or U.S. Coast Guard.
Yes
No
Form I-864 07/02/15 N
Page 4 of 12
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