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Get USCIS I-864A 2012

Information on the Household Member. (You.) 1. Name Last Name First Name 2. Mailing Address Middle Name Street Number and Name (include apartment number) City 3. Place of Residence (if different from mailing address) Zip/Postal Code is the intending immigrant. State or Province Country This I-864A relates to a household member who: is not the intending immigrant. Street Number and Name (include apartment number) City State or Province Country Zip/Postal Code 4. Telephone Number .

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