Information On Sponsor (Person Filing The Form I-864) (Page 3 of 3) in pdf

Information On Sponsor (Person Filing The Form I-864) Page 3

List below persons for whom you previously have submitted INS Form I-864, if your support obligation has

not terminated.

Name

A-Number (If Any)

Date Affidavit of Support Signed

Relationship (Ex. Spouse, Son, Daughter, etc.)

Name

A-Number (If Any)

Date Affidavit of Support Signed

Relationship (Ex. Spouse, Son, Daughter, etc.)

Name

A-Number (If Any)

Date Affidavit of Support Signed

Relationship (Ex. Spouse, Son, Daughter, etc.)

SPONSOR'S ANNUAL HOUSEHOLD INCOME (Circle 1, 2, 3, 4, or 5)

I filed a single/separate tax return for the most recent tax year.

I filed a joint return for the most recent tax year which includes only my own income.

I filed a joint return for the most recent tax year which includes income for my spouse and myself.

I am submitting documentation of my individual income (Forms W-2 OR 1099).

I am qualifying using my spouse's income; my spouse is submitting a Form I-864A.

Information for most recent tax year

Sponsor's individual income

$_____________________

Sponsor and spouse's combined income

$____________________

(If spouse's income is to be considered, spouse must submit Form I-864A)

SPONSOR’S ASSETS (IF USING TO MEET POVERTY GUIDELINES)

Type of Asset

Cash Value of Assets (Subtract any debts)

Savings deposits

$_____________________

Stocks, bonds, certificate of deposit

$_____________________

Life insurance cash value

$_____________________

Real estate

$_____________________

Other (Specify) ___________________

$_____________________

Total Cash Value of Assets

$____________________

Information On Sponsor (Person Filing The Form I-864) Page 3