I-864

I-864 AFFIDAVIT OF SUPPORT

I, Sponsor Name: , residing at , being duly sworn, declare under penalty of perjury under the laws of the United States that the statements in this Affidavit of Support are true and correct.

Beneficiary Name: ; Alien Registration Number (if any): ; Relationship to sponsor: .

RECITALS

WHEREAS, the beneficiary seeks admission to the United States or adjustment of status based in whole or in part on a family-based petition filed by or on behalf of the sponsor; and

WHEREAS, the sponsor is willing and able to undertake the legal obligations described in this Affidavit to demonstrate that an intending immigrant will not become a public charge; and

WHEREAS, this Affidavit of Support establishes a legally enforceable contract between the sponsor and the intending immigrant and provides a basis for agencies to seek enforcement as permitted by law.

NOW, THEREFORE, in consideration of the admission or adjustment of status of the beneficiary, the sponsor hereby agrees as follows:

1. SPONSOR IDENTIFICATION AND STATUS

U.S. Citizen Lawful Permanent Resident Other:

2. FINANCIAL INFORMATION AND OBLIGATION

Sponsor certifies that current total annual household income from all sources is $ and that the household size for purposes of determining income adequacy is persons. Sponsor agrees to maintain sufficient income and/or assets so that the intending immigrant will not become primarily dependent on public assistance.

Sponsor acknowledges and accepts a binding obligation to provide financial support to the beneficiary and to reimburse any governmental agency or program that provides means-tested public benefits to the beneficiary that are attributable to the sponsor's failure to provide support, to the extent permitted by applicable law. This obligation arises upon the beneficiary's admission to the United States or adjustment of status and continues until the earliest of:

1. the beneficiary becomes a U.S. citizen;
2. the beneficiary has earned or acquired—through work or a combination of work and receipt of means-tested public benefits—40 qualifying quarters of coverage under applicable law;
3. the beneficiary departs the United States and is not readmitted; or
4. the sponsor's obligation is terminated by operation of law or as provided by statute.

3. INCOME, ASSETS, AND DOCUMENTATION

Primary evidence of income and resources is attached as indicated below. Sponsor affirms that all attached documents are true, correct, and complete copies of original records.

Copies of federal (or applicable) income tax returns for the most recent tax year
W-2 forms or equivalent
Recent pay stubs showing year-to-date earnings
Bank statements: total liquid assets $

4. JOINT SPONSOR OR HOUSEHOLD MEMBER CONTRIBUTION

If the sponsor's income and assets are insufficient, a joint sponsor or household member may undertake the obligations of this Affidavit. A joint sponsor must complete a separate affidavit and provide supporting financial documentation.

5. ENFORCEMENT, REIMBURSEMENT, AND REMEDIES

The sponsor acknowledges that this Affidavit creates a legally enforceable obligation. The beneficiary or any agency providing means-tested public benefits to the beneficiary may bring an action to enforce this obligation. Sponsor further agrees to reimburse any such agency for benefits provided to the beneficiary to the extent permitted by law and to pay any costs, interest, or reasonable attorney's fees awarded by a court.

6. NOTICES

All notices required under this Affidavit shall be sent to the sponsor at the address provided above or to the most recent address on file with the relevant immigration authority. For purposes of internal communication, the sponsor's preferred telephone number is and email .

7. AMENDMENTS, WAIVER, ENTIRE AGREEMENT

Any amendment or waiver of any provision of this Affidavit must be in writing and signed by the sponsor and, where applicable, the joint sponsor. No waiver by any party of any breach shall be deemed a waiver of any subsequent breach. This Affidavit constitutes the entire agreement between the sponsor and the beneficiary concerning the obligations described herein, superseding all prior oral or written agreements.

8. GOVERNING LAW; SEVERABILITY

This Affidavit shall be governed by and construed in accordance with the laws of the United States and, where applicable, the law of the state in which enforcement proceedings are brought. If any provision of this Affidavit is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

9. CERTIFICATION UNDER PENALTY OF PERJURY

I certify, under penalty of perjury under the laws of the United States of America, that I have read and understood this Affidavit of Support and that the information I have provided is true and correct to the best of my knowledge and belief. I understand that knowingly and willfully making a false statement on this Affidavit may subject me to penalties for perjury and other applicable penalties.

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