Professional Documents
Culture Documents
Form I-864EZ
Department of Homeland Security OMB No. 1615-0075
U.S. Citizenship and Immigration Services Expires 07/31/2017
2.e. State 2.f. ZIP Code 2.e. State AZ 2.f. ZIP Code 85295
If you answered "No" to Item Number 3., provide your Part 4. Information About Your Household Size
physical address below.
NOTE: Do not count any household member more than once.
Physical Address 1.a. Yourself and the person you are sponsoring on this Form
I-864EZ.
2
4.a. Street Number
and Name
1.b. Your spouse. 1
4.b. Apt. Ste. Flr.
1.c. Your dependent children under 21 years of age. 0
4.c. City or Town
1.d. If you have sponsored any other persons on a Form I-864
4.d. State 4.e. ZIP Code who are now lawful permanent residents in the United
States, enter the number here.
0
4.f. Province
1.e. If you have any other dependents listed on your most
4.g. Postal Code recent Federal income tax return, enter the number here.
0
4.h. Country
1.f. Add together Item Numbers 1.a. - 1.e. and enter the
number here. This is your HOUSEHOLD SIZE for the
purpose of this Form I-864EZ.
3
Other Information
5. Country of Domicile
United States of America Part 5. Information About Your Employment
and Income
6. Date of Birth (mm/dd/yyyy) 02/03/1986
1. I am currently:
7. City or Town of Birth Employed (Complete Item Numbers 2.a. - 2.c.)
Retired (Complete Item Numbers 3.a. - 3.b.)
8. State or Province of Birth (if applicable)
2.a. Current Occupation
9. Country of Birth
2.b. Name of Employer 1 (if applicable)
Vietnam
10. U.S. Social Security Number (Required)
2.c. Name of Employer 2 (if applicable)
6 9 8 0 3 5 9 5 5
Sponsor's Signature
Interpreter's Contact Information
6.a. Sponsor's Signature
Don't forget to sign! 4. Interpreter's Daytime Telephone Number
3.h. Country
6.d.
3.d.
4.d.