Form I-864ez - Affidavit Of Support Under Section 213a Of The Act
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7Affidavit of Support Under Section 213A of the INA
USCIS
Form I-864EZ
Department of Homeland Security
OMB No. 1615-0075
U.S. Citizenship and Immigration Services
Expires 07/31/2017
For Government Use Only
This Form I-864EZ:
DOES NOT MEET
MEETS the
Reviewed By:
the requirements of
requirements of
Location:
Date (mm/dd/yyyy):
INA section 213A
INA section 213A
►
START HERE. Type or print in black ink.
Part 1. Qualifying to Use Form I-864EZ
Other Information
1.a.
I am the petitioner of the family member sponsored on
3.
Daytime Telephone Number
this affidavit.
Yes
No (Use Form I-864)
1.b.
I am using my own earned or retirement income, which is
4.
Date of Birth (mm/dd/yyyy)
documented using Internal Revenue Service (IRS) Form
W-2.
5.
Alien Registration Number (A-Number) (if any)
Yes
No (Use Form I-864)
►
A-
1.c. The sponsored immigrant is the only person immigrating
based on the underlying visa petition.
6.
USCIS ELIS Account Number (if any)
►
Yes
No (Use Form I-864)
7.
U.S. Social Security Number (if any)
►
Part 2. Information About the Immigrant You
Are Sponsoring (Intending Immigrant)
Part 3. Information About You (Sponsor)
Name of Immigrant
1.a. Family Name
1.a. Family Name
(Last Name)
(Last Name)
1.b. Given Name
1.b. Given Name
(First Name)
(First Name)
1.c. Middle Name
1.c. Middle Name
Mailing Address
Mailing Address
2.a. In Care Of Name
2.a. In Care Of Name
2.b.
Street Number
2.b.
Street Number
and Name
and Name
2.c.
2.c.
Apt.
Ste.
Flr.
Apt.
Ste.
Flr.
2.d. City or Town
2.d. City or Town
2.e. State
2.f.
ZIP Code
2.e. State
2.f.
ZIP Code
2.g. Province
2.g. Province
2.h. Postal Code
2.h. Postal Code
2.i.
Country
2.i.
Country
Form I-864EZ 07/02/15 N
Page 1 of 7
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