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SAMPLE I-864 Form - Affidavit of Support Under Section ...

Affidavit of Support Under Section 213A of the ActDepartment of Homeland Security Citizenship and Immigration ServicesUSCISForm I-864 OMB No. 1615-0075 Expires 03/31/2015 START HERE - Type or print in black ink. form I-864 03/22/13 NPage 1 of 9 Part 1. Basis For Filing Affidavit of Supportam the sponsor submitting this Affidavit of Support because (Check only one box):I am the petitioner. I filed or am filing for the immigration of my filed an alien worker petition on behalf of the intending immigrant, who is related to me as have an ownership interest of at least 5 percent inI am the only joint am theThe original petitioner is deceased.

Affidavit of Support Under Section 213A of the Act Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-864 OMB No. 1615-0075

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