Download I-864A Contract for U.S. Immigration Sponsor and Household Member and more Exercises Property Law in PDF only on Docsity!
I-864A, Contract Between
Sponsor and Household Member
OMB No. 1615-0075; Expires 03/31/
Part 1. Information on the Household Member. (You.)
Middle Name
1. Name Last Name
First Name
State or Province
2. Mailing Address Street Number and Name (include apartment number)
City
Country Zip/Postal Code
4. Telephone Number (Include area code or country and city codes)
5. Date of Birth (mm/dd/yyyy)
7. U.S. Social Security
Number (if any)
This I-864A relates to a household member who:
is the intending immigrant.
is not the intending immigrant.
Reviewer
Location
Date (mm/dd/yyyy)
State or Province
3. Place of Residence Street Number and Name (include apartment number)
City
Country Zip/Postal Code
(if different from
mailing address)
6. Place of Birth City State/Province Country
a. I am the intending immigrant and also the sponsor's spouse.
Relationship to Sponsor (Check either a, b or c.)
b. I am the intending immigrant and also a member of the sponsor's household.
c. I am not the intending immigrant. I am the sponsor's household member. I am
related to the sponsor as his/her.
Spouse
Son or daughter (at least 18 years old)
Other dependent (specify)
Parent
Brother or sister
Form I-864A (03/22/13) Y
Department of Homeland Security U.S. Citizenship and Immigration Services
For Government Use Only
Name of Employer No. 1 (if applicable).
$___________________________.
Form I-864A (03/22/13) Y Page 2
For Government Use Only
9. I am currently:
a. Employed as a/an.
Name of Employer No. 2 (if applicable).
b.^ Self-employed as a/an^.
c.^ Retired from
d.^ Unemployed since
since. (Company Name) (mm/dd/yyyy)
(mm/dd/yyyy)
10. My current individual annual income is: $__________________________________________.
**11. Federal income tax information.
- My assets (complete only if necessary).**
a. Enter the balance of all cash, savings, and checking accounts.
Enter the net cash value of real-estate holdings. (Net means assessed value minus mortgage debt.)
b.
$___________________________.
Enter the cash value of all stocks, bonds, certificates of deposit, and other assets not listed on line a or b.
c.
$___________________________.
d. Add together Lines a, b, and c and enter the number here. $___________________________.
(Optional) I have attached photocopies or transcripts of my Federal tax returns for my
second and third most recent tax years.
I have filed a Federal tax return for each of the three most recent tax years. I have
attached the required photocopy or transcript of my Federal tax return for only the
most recent tax year.
Tax Year
(most recent)^ $
My total income (adjusted gross income on IRS Form 1040EZ) as reported on my
Federal tax returns for the most recent three years was:
(2nd most recent) $
(3rd most recent)^ $
Total Income
