Form I-134 - Affidavit Of Support
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8USCIS
Affidavit of Support
Form I-134
Department of Homeland Security
OMB No. 1615-0014
U.S. Citizenship and Immigration Services
Expires 11/30/2018
► START HERE - Type or print in black ink.
Part 1. Information About You (the Sponsor)
Sponsor's Physical Address
5.a.
Street Number
Your Full Name
and Name
1.a. Family Name
5.b.
Apt.
Ste.
Flr.
(Last Name)
1.b. Given Name
5.c.
City or Town
(First Name)
1.c. Middle Name
5.d.
State
5.e. ZIP Code
5.f.
Province
Other Names Used
5.g.
Postal Code
List all other names you have ever used, including aliases,
maiden name, and nicknames. If you need extra space to
5.h.
Country
complete this section, use the space provided in Part 7.
Additional Information.
2.a. Family Name
Other Information
(Last Name)
2.b. Given Name
(First Name)
6.
Date of Birth (mm/dd/yyyy)
2.c. Middle Name
7.a. Town or City of Birth
Sponsor's Mailing Address
7.b. Country of Birth
3.a.
In Care Of Name
8.
Alien Registration Number (A-Number) (if any)
3.b.
Street Number
►
A-
and Name
9.
U.S. Social Security Number (if any)
3.c.
Apt.
Ste.
Flr.
►
3.d.
City or Town
10.
USCIS Online Account Number (if any)
►
3.e.
State
3.f.
ZIP Code
3.g.
Province
Citizenship or Residency or Status
3.h.
Postal Code
If you are not a U.S. citizen based on your birth in the United
States, or a non-citizen U.S. national based on your birth in
3.i.
Country
American Samoa (including Swains Island), answer the
following as appropriate:
4.
Are your mailing address and physical address the same?
11.a.
I am a U.S. citizen through naturalization. My
Certificate of Naturalization number is
Yes
No
If you answered "No" to Item Number 4., provide your
physical address in Item Numbers 5.a. - 5.h.
11.b.
I am a U.S. citizen through parent(s) or marriage.
My Certificate of Citizenship number is
Form I-134 11/30/16 N
Page 1 of 8
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