INFORMATION ON SPONSOR (PERSON FILING THE FORM I-864)
Family Name (Last Name)
First Name (Given Name)
Middle Name
Current Address (Street Number & Name)
City
State or Province
Country
Zip/Postal Code
Telephone Number:
(
)
Date of Birth (Month, Day, Year)
Place of Birth (City, State, Country)
Circle one: Are you a U.S. Citizen?
/
/
Yes
No
Social Security Number
A-Number (If Any)
INFORMATION ON THE IMMIGRANT(S) YOU ARE SPONSORING
Family Name (Last Name)
First Name (Given Name)
Middle Name
Date of Birth (Month, Day, Year)
Sex (Circle one)
Social Security Number (if any)
/
/
Male
Female
Country of Citizenship
A-Number (If any)
Current Address (Street Number & Name)
City
State or Province
Country
Zip/Postal Code
Telephone Number:
(
)