Exam

Affidavit of Support Under Section 213A of the INA

Department of Homeland Security

U.S. Citizenship and Immigration Services

For

USCIS

Use

Only

Affidavit of Support Submitter

Petitioner

1st Joint Sponsor

2nd Joint Sponsor

Substitute Sponsor

5% Owner

OMB No. 1615-0075

Expires 07/31/2017

Section 213A Review

MEETS

requirements

USCIS

Form I-864

Number of Support Affidavits in File

DOES NOT MEET

requirements

Reviewed By:

Office:

Date (mm/dd/yyyy):

1

2

Remarks

►START HERE - Type or print in black ink.

Part 2. Information About the Principal

Immigrant

Part 1. Basis For Filing Affidavit of Support

I,

am the sponsor submitting this affidavit of support because

(Select only one box):

1.a.

I am the petitioner. I filed or am filing for the

immigration of my relative.

1.b.

,

I filed an alien worker petition on behalf of the

intending immigrant, who is related to me as my

1.c.

I have an ownership interest of at least 5 percent in

which filed an alien worker petition on behalf of the

intending immigrant, who is related to me as my

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

Mailing Address

2.a. In Care Of Name

2.b. Street Number

and Name

2.c.

1.d.

I am the only joint sponsor.

1.e.

I am the

1.f.

The original petitioner is deceased. I am the

substitute sponsor. I am the intending immigrant's

first

second of two joint sponsors.

NOTE: If you select Item Number 1.a., 1.b., 1.c., 1.d., 1.e.,

or 1.f., you must include proof of your U.S. citizenship, U.S.

national status, or lawful permanent resident status.

Form I-864 07/02/15 N

Apt.

Ste.

Flr.

2.d. City or Town

2.e. State

2.f.

ZIP Code

2.g. Province

2.h. Postal Code

2.i.

Country

Page 1 of 12

Part 2. Information About the Principal

Immigrant (continued)

7.

Other Information

Family Member 2

3.

Country of Citizenship or...