Form I-864A, Contract Between Sponsor and Household …

Son or Daughter (at least 18 years of age) Parent Brother or Sister. Other Dependent (Specify) I am currently: Employed as a/an Self employed as a/an. Retired from (Company Name) Name of Employer Number 1 . Name of Employer Number 2 (if applicable) Since (mm/dd/yyyy) Unemployed since (mm/dd/yyyy) 7. $ My current individual annual income is: ................
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