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Y This Form I-864A relates to a household member who: IS the intending immigrant IS NOT the intending immigrant To be completed by an attorney or accredited representative (if any). Select this box if Form G-28 or G-28I is attached. Reviewed By: Location: Date (mm/dd/yyyy): Attorney State Bar Number (if applicable) Attorney or Accredited Representative USCIS Online Account Number (if any) START HERE - Type or print in black ink. Part 1. Information About You (the Household Member) F.

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