Fill and Sign the Proof of Residency Documents Form

Affidavit of Citizen or Resident of United States in Support of Relatives Desiring to Emigrate State of __________________________ County of ________________________ ________________________ (Name of Affiant) , being first duly sworn, deposes and says: 1. I __________________________ (was born a citizen of the United States ) on _________________ (date of birth) in ____________________ (name of city) , ____________________ (name of county) County, ____________________ (name of state) and was naturalized a citizen of the United States on __________________ (date of naturalization) in __________________ (name of city) , ____________________ (name of county) , _____________________ (name of state) by the ______________ __________________ (name of court) , and was issued Certificate No. _____________ (number of certificate) . I am not a citizen of the United States, but I was lawfully admitted to the United States for permanent residence on __________________ (date of admittance) , at __________________ (port of entry) on the ___________________ (name of vessel or other means of conveyance) . 2. I am _________ (number of years of age) years of age and have resided in the United States since _____________ (identification of month) , ________ (identification of year) . 3. It is my intention and desire to have the following persons, at present residing at ______________________________________________________________________ (address of residence of relatives) , emigrate to the United States: (description of name, sex, age, country of birth, marital status, and relationship to affiant of each prospective immigrant) _________________________________________________ ______________________________________________________________________ ______________________________________________________________________ . 4. I am employed as or engaged in the business of ______________________ (name of affiant's business or profession) with _____________________________ (name of affiant's employer) at ____________________________________________________ _____________________ (business address of affiant's employer) , and derive a net annual income of $______________ (dollar amount of annual income of affiant) from the business. In addition, I have assets consisting of (description of affiant's investments, savings, life insurance, real property, and similar such information) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ . 5. I am ______________ (married or single) and the following persons are dependent on me for support: __________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ (name, age, and relationship to affiant of each person wholly or partially dependent on affiant for support) . 6. OPTIONAL : I have previously submitted affidavits of support for the following persons: (description of name of each person and date affidavit submitted) _____________ ______________________________________________________________________. 7. OPTIONAL: I have submitted petitions for issuance of immigration visas on behalf of the following persons : (description of name and relationship to affiant of each person, and date each petition submitted) _________________________________________ ______________________________________________________________________. 8. I am willing and able to receive, maintain, and support the prospective immigrants listed in Paragraph 3 above, and I am ready and willing to deposit a bond, if necessary, with the United States immigration authorities to guarantee that these prospective immigrants will not become public charges during their stay in the United States. 9. This affidavit is made by me for the purpose of assisting the American Consul and the Bureau of Citizenship and Immigration Services in determining that the persons named above are not persons who will become public charges if they are admitted to the United States. ________________________________ (Signature of Affiant) ________________________________ (Print or Type Name) SWORN to and subscribed before me, this the ______ day of ______________, 20______. __________________________ NOTARY PUBLIC My Commission Expires: _______________________