Affidavit of Support

State of

County of

I, , of legal age, residing at , in the State of , do hereby solemnly affirm and declare that I am willing and able to support residing at for the duration of their stay in the United States.

Relationship to Applicant:

I understand that this affidavit is made for the purpose of assuring the U.S. government that the above-named applicant will not become a public charge while in the United States.

Employment/Occupation:

Annual Income:

Number of Dependents:

I certify under penalty of perjury that the foregoing is true and correct.

Signature Date

Printed Name Contact Number