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United States of America
County of    } SS
State of     }

Affidavit of Support

(Name) residing at (Street Address)
(City) (State) being duly sworn depose and say:

1. That I am a native born citizen of the United States having been born in the
City of
State of

That I was naturalized a citizen United States on: 
Date    In
(City)  (County)
(State)  number of my certificate being
issued by the Court of

That I declared my intention of becoming a citizen of the United States on:
Date   In the 
(City)  (County)
(State) number of my certificate being
issued by the Court of

2. That it is my (our) intention and desire to have my (our) relatives whose names appear below, at present residing at:

(Give complete address)

come to the United States for permanent residence. 

[[6 Columned Table]]
| Name of Alien | Sex | Date of Birth | Country of Birth | Occupation| Relationship to Deponent |
| --- | --- | --- | --- | --- | --- |

3. That my regular occupation is  (Business Name and Address)
and my average earnings amount to $

4. That I (We) possess the following financial assets of which corroborative evidence is herewith attached:

5. That my (our) dependents consist of

That I (We) am (are) willing and able to receive, maintain, support the alien(s) after their immigration to the United States, and hereby assume such obligations guaranteeing that none of them will at any time become public charges upon any community in the United States; and that any of school age will be sent to school.

SWORN TO ME BEFORE THIS
    DAY OF    193

Transcription Notes:
---------- Reopened for Editing 2024-02-11 00:29:03 ---------- Reopened for Editing 2024-02-11 10:36:40