3 4 5 9  Lawrenceville - Suwanee  Rd., Suite A,  Suwanee ,  Georgia

Tel: (770) 271-5244 ● Toll Free:  (888) 768-7252 ● Fax: (770) 271-5604 ● Cornel@PotraLawFirm.com ● www.potralawfirm.com

Attorneys:  Cornel Potra – Admitted: Georgia & Washington  ●  Kristina F Potra – Admitted: Georgia

This questionnaire is for the exclusive use of Potra Law Firm.  Please answer all the questions.  Do not leave any questions unanswered.  If you do not have an answer to a question, please insert “N/A”.  It is your responsibility to provide true and accurate information, as well as the evidentiary documents requested. 

This Document Is For The Attorney’s Office Use Only

 

  

QUESTIONNAIRE I-864

SPONSOR
 

Personal Information

 

1. Full Name

a. Family name

 b. First name

c. Middle name

 
2. Information about the IMMIGRANT (person you are filing for)

a. Full Name

Family name

 First name

Middle name

 
 

b. Mailing address of the person you are filing for

       Street number
       Apt.
       City
       State (Province)
       Country  
       Zip Code
 

c. Country of nationality

d. Date of Birth month/day/year

e. Alien Number (A#) (if applicable)

 

f. Social Security Number (if applicable)

 

 

3. Please indicate the family members immigrating at the same time or within six months of the principal immigrant named above:

 

A. a. Family Name
b. First Name
c. Middle Name
d. Relationship to the sponsored immigrant
e. Date of birth month/day/year
f. Alien Number (A#-if it applies)
g. Social Security Number (if it applies)

 

B. a. Family Name
b. First Name
c. Middle Name
d. Relationship to the sponsored immigrant
e. Date of birth month/day/year
f. Alien Number (A#-if it applies)
g. Social Security Number (if it applies)

 

C. a. Family Name
b. First Name
c. Middle Name
d. Relationship to the sponsored immigrant
e. Date of birth month/day/year
f. Alien Number (A#-if it applies)
g. Social Security Number (if it applies)

 

D. a. Family Name
b. First Name
c. Middle Name
d. Relationship to the sponsored immigrant
e. Date of birth month/day/year
f. Alien Number (A#-if it applies)
g. Social Security Number (if it applies)

 

E. a. Family Name
b. First Name
c. Middle Name
d. Relationship to the sponsored immigrant
e. Date of birth month/day/year
f. Alien Number (A#-if it applies)
g. Social Security Number (if it applies)

 

For additional family members, use the space below.

It is very important that you respect the order of the information requested.

 Information about the sponsor
 

4. Your place of residence:

   a. Street  number

   b. City

   c. State/Province

   d. Zip code

   e. Country

   f. Telephone

 

 

5. Country of domicile

6. Date of Birth month/day/year

7. Place of birth City/State/Country

8. Social Security Number

 

 

9. Please select one of the following:

 

10. Alien Number (A#)

11. Are you currently on active duty in the U.S. armed services? 

12. Are you married?

13. Do you have dependent children?

      If yes, give the number of children

14. Do you have any other dependents?
      If yes, give the number of other dependents

15. Have you ever sponsored any other persons who are now permanent residents?

      If yes, please give the number

 

 

16. Please select one of the following, and give details:

     Name of employer          
company's name
month/day/year

 

 
17. Your current individual income
18. Did you file federal taxes for the last three fiscal years?

 

 

19. Indicate the individual annual income for the last three fiscal years:

 

Tax year

Total Income
a.

b.

c.

 

 

Please indicate:

20.The balance of all cash,  savings and checking accounts

   

21. The net cash value of real-estate holdings (net means assessed value minus mortgage debt)

  

22. Indicate the net cash value of all stocks, bonds, certificates of deposit,

      and any other assets not included above
 
   

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

Documents necessary to file I-864 to the U.S Department of Homeland Security:

  
* Your federal tax income returns for the last three fiscal years
 
*

Letter from current employer (must be on company letterhead) attesting to:

 

a. Your Name

b. Position (occupation)

c. Rate of Pay

d. Date of employment

 

The letter should contain the company's header and signature of the legal representative.

If you are self-employed, please write a personal letter and mention the nature of your business, the date when you started and the income.

Please don't forget to sign it.

 

  
 
 
 
 
 
 
 
 
*

A copy of the Citizenship Certificate, Passport, or Birth Certificate, or, if you are not a U.S. citizen, a copy of your Green Card

  
 

NOTE: THIS DOCUMENT IS THE PRODUCT OF POTRA LAW FIRM. THE USE OF THIS QUESTIONNAIRE BY OTHER INDIVIDUALS OR LAW FIRMS IN ASSISTING OTHERS WITH THE COMPLETION OF DOCUMENTS, OR FOR ANY OTHER PURPOSES, IS STRICTLY PROHIBITED.   POTRA LAW FIRM MAINTAINS ITS COPYRIGHTS OVER THE TRANSLATION OF THIS DOCUMENT.  PERMISSION TO USE THIS DOCUMENT MAY BE OBTAINED ONLY FROM POTRA LAW FIRM.  COPYRIGHT © January 17, 2007.