Affidavit I-864 Document

AFFIDAVIT I-864 DOCUMENT

This Affidavit I-864 Document is executed on by Sponsor Name: , Sponsor Address: , and Beneficiary Name: (collectively, the "Parties").

RECITALS

WHEREAS, Sponsor affirms an intent to support Beneficiary pursuant to the affidavit of support obligation commonly referenced as I-864, by providing financial maintenance and ensuring that Beneficiary will not become a public charge; and

WHEREAS, Sponsor represents that Sponsor's current household size is persons and that Sponsor's current annual income is $, as further evidenced by the documentation described herein; and

WHEREAS, the Parties desire to set forth the Sponsor's obligations, certifications, and remedies available to the Beneficiary in the event of failure to provide support.

NOW THEREFORE

In consideration of the mutual covenants contained herein, and for other good and valuable consideration, the receipt and sufficiency of which are acknowledged, Sponsor and Beneficiary agree as follows:

1. AFFIANT'S OBLIGATION OF SUPPORT

1.1 Sponsor affirms, warrants, and covenants that Sponsor will maintain adequate means of financial support for Beneficiary at a level not less than 125% of the Federal Poverty Guidelines applicable to Sponsor's household size, as measured at the time of filing and as may be required thereafter. Sponsor agrees to provide for the basic needs of Beneficiary, including but not limited to housing, food, medical care, and other necessities of life, until such time as Beneficiary becomes a U.S. citizen, can be credited with 40 qualifying quarters of work, departs the United States, or dies, whichever occurs first.

1.2 Sponsor acknowledges that this obligation is a legally enforceable contract between Sponsor and Beneficiary and that a civil action for support may be brought against Sponsor by or on behalf of Beneficiary.

2. REPRESENTATIONS AND WARRANTIES

2.1 Sponsor represents and warrants that all statements made in connection with this Affidavit, including statements regarding income, household composition, assets, and employment, are true and complete to the best of Sponsor's knowledge. Sponsor will promptly notify Beneficiary in writing of any material change in Sponsor's ability to provide support.

2.2 Sponsor represents that Sponsor's present employer is: and Sponsor's occupation is: .

3. INCOME, ASSETS, AND DOCUMENTATION

3.1 Sponsor certifies that Sponsor's annual income from all sources is $. If Sponsor relies upon assets to meet the support requirement, Sponsor lists such assets and their fair market value below.

3.2 Sponsor agrees to provide, upon request by Beneficiary or an authorized representative, true and correct copies of documentation supporting the income and assets certified herein, including but not limited to federal income tax returns, pay stubs, employer verification letters, bank statements, and deeds or titles for assets.

4. ENFORCEMENT, REIMBURSEMENT, AND LIMITATIONS

4.1 Beneficiary may bring a civil action to enforce this Affidavit and to recover the reasonable costs of enforcement, including court costs and attorney fees, where permitted by applicable law. Sponsor acknowledges that obligations under this Affidavit are independent of any public benefits that Beneficiary may receive.

4.2 Sponsor's liability to Beneficiary under this Affidavit is limited to the amounts necessary to provide the support described herein; however, such liability shall not be reduced by any other agreement unless confirmed in writing and signed by both Parties.

5. NOTICES

5.1 Any notice required or permitted under this Affidavit shall be in writing and delivered personally or by certified mail, return receipt requested, to the addresses provided in this document or to such other address as a Party may designate by written notice to the other Party. Notices shall be deemed given upon receipt.

6. AMENDMENTS AND WAIVER

6.1 This Affidavit may be amended only by a written instrument executed by both Parties. No waiver of any breach of any provision of this Affidavit shall be effective unless in writing and signed by the Party against whom enforcement of the waiver is sought.

7. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

7.1 Governing Law. This Affidavit shall be governed by and construed in accordance with the laws of the state of , without regard to its choice of law principles.

7.2 Severability. If any provision of this Affidavit is determined to be invalid, illegal or unenforceable, the remaining provisions shall remain in full force and effect, and the invalid provision shall be reformed only to the extent necessary to make it enforceable.

7.3 Entire Agreement. This Affidavit, together with any exhibits and attachments expressly incorporated herein, constitutes the entire agreement between the Parties with respect to the subject matter and supersedes all prior and contemporaneous agreements and understandings, both written and oral.

8. COUNTERPARTS

8.1 This Affidavit may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one instrument. Signatures transmitted by facsimile or electronic image shall be binding for all purposes.

9. ADDITIONAL ACKNOWLEDGMENTS

9.1 Sponsor acknowledges that Sponsor has been given the opportunity to seek independent legal counsel concerning the obligations assumed herein, that Sponsor has read and understands the terms of this Affidavit, and that Sponsor executes this Affidavit freely and voluntarily.

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