Affidavit of Support Form
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Please complete the following in detail:
Liebman-Mimbu Client Number
» Information About the Sponsor
Family Name
Given Name
Middle Name
Birthdate
Male
Female
Nationality
All other names used (including maiden)
City and country of birth
Home Telephone
Marital Status
Married
Single
Divorced
Seperated
Widowed
Place of Birth
U.S. Citizen? Yes
No
Social Security Number
A Number
» Information The Sponsor's Current Residence & Employment (or School)
Current Residence
City & Country
Current Employer
Salary
Self Employed?
» Information About the Immigrant Being Sponsored
Family Name
Given Name
Middle Name
Birthdate
Male
Female
Nationality
All other names used (including maiden)
City and country of birth
Home Telephone
Marital Status
Married
Single
Divorced
Seperated
Widowed
Place of Birth
Social Security Number
A Number
» General Sponsor Information
Most Recent U.S. Tax Year Filed
2000
1999
1998
1997
Have not filed US tax returns
Filed As
Have not filed
single/seperate tax return
joint return with only my income
joint return with my income and my spouse's income
Total Household Income
Number of Persons (related to sponsor by birth, marriage or adoption
not
being sponsored by this affidavit) Living in Household
Number of Immigrants Sponsored in This Affidavit
Number of Immigrants Under Previous Afffidavits
Number of Persons otherwise Dependant on You and Included in Your Tax Return
Total Household Size
Notes:
Your email address:
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