Homepage >> Download USCIS I-134 Template

Misconceptions

The USCIS I-134 form, also known as the Affidavit of Support, is often misunderstood. Here are four common misconceptions about this important document:

  • Misconception 1: The I-134 form guarantees visa approval.
  • Many believe that submitting the I-134 form will automatically lead to the approval of a visa application. In reality, while the form demonstrates financial support, it does not guarantee that the visa will be granted. The decision ultimately rests with the USCIS or the consular officer.

  • Misconception 2: Only U.S. citizens can fill out the I-134 form.
  • Another common belief is that only U.S. citizens are eligible to complete this form. However, lawful permanent residents can also serve as sponsors. It is essential to understand the eligibility criteria when preparing to file.

  • Misconception 3: The I-134 form requires a specific income level.
  • Some people think there is a fixed income threshold that must be met to use the I-134 form. In fact, while the form does require sponsors to demonstrate their ability to support the applicant, there is no strict income requirement. The sponsor's financial situation will be evaluated based on various factors.

  • Misconception 4: The I-134 form is the only document needed for sponsorship.
  • Many assume that the I-134 form alone suffices for sponsorship. However, additional documentation, such as proof of income and relationship to the applicant, may also be necessary. Gathering the right supporting documents is crucial for a successful application.

File Details

Fact Name Description
Purpose The I-134 form is used to demonstrate financial support for a non-citizen applying for a visa or adjustment of status.
Who Uses It? U.S. citizens and lawful permanent residents can file the I-134 form on behalf of the applicant.
Submission Requirement This form must be submitted to the U.S. Citizenship and Immigration Services (USCIS) as part of the visa application process.
Supporting Documents Along with the I-134, sponsors should include proof of income and assets, such as tax returns and bank statements.
Validity Period The I-134 form remains valid as long as the financial situation of the sponsor supports the applicant's needs.
State-Specific Laws While the I-134 is a federal form, state laws regarding financial support may vary. It's advisable to consult local regulations.

Key takeaways

When filling out and using the USCIS I-134 form, there are several important points to keep in mind. This form, known as the Affidavit of Support, is a critical document for individuals seeking to sponsor a visa applicant. Below are key takeaways to ensure proper completion and usage of the form.

  • Understand the Purpose: The I-134 form is used to demonstrate that a visa applicant has adequate financial support and will not become a public charge in the United States.
  • Eligibility Requirements: The sponsor must be a U.S. citizen or a lawful permanent resident. They must also meet specific income requirements to ensure they can support the applicant.
  • Accurate Information: All information provided on the form must be truthful and accurate. Misrepresentation can lead to serious legal consequences.
  • Documentation: Along with the form, sponsors should provide supporting documents, such as proof of income, tax returns, and bank statements, to substantiate their financial claims.
  • Signature Requirement: The form must be signed by the sponsor. An unsigned form will be considered incomplete and may delay the visa application process.
  • Submission Process: The completed I-134 form should be submitted to the appropriate USCIS office or consulate as instructed in the visa application process.
  • Validity Period: The I-134 form is generally valid for a specific period. It's important to check the current guidelines to ensure the form is submitted within the required timeframe.
  • Consulting Legal Advice: If there are any uncertainties or complexities regarding the sponsorship, seeking legal advice can help clarify obligations and ensure compliance with immigration laws.

Dos and Don'ts

When completing the USCIS I-134 form, it's important to follow guidelines to ensure your application is processed smoothly. Here’s a list of things you should and shouldn’t do.

  • Do read the instructions carefully before filling out the form.
  • Do provide accurate and truthful information.
  • Do sign and date the form where required.
  • Do keep a copy of the completed form for your records.
  • Don’t leave any required fields blank; if something doesn’t apply, indicate that.
  • Don’t use white-out or erase any mistakes; simply cross them out and write the correct information.
  • Don’t submit the form without checking for errors or omissions.
  • Don’t forget to include any necessary supporting documents.

By following these guidelines, you can help ensure that your I-134 form is filled out correctly and submitted successfully.

Common mistakes

  1. Inaccurate Information: Many individuals provide incorrect personal details such as names, addresses, or dates of birth. Double-checking this information is crucial.

  2. Missing Signatures: Failing to sign the form is a common oversight. Remember, an unsigned form will be rejected.

  3. Incomplete Sections: Some applicants skip sections or fail to provide all required information. Each part of the form must be filled out completely.

  4. Wrong Filing Fee: Not including the correct filing fee or submitting payment in the wrong format can lead to delays. Always check the current fee schedule.

  5. Outdated Version: Using an outdated version of the I-134 form can result in rejection. Ensure you are using the most recent form available on the USCIS website.

  6. Failure to Provide Supporting Documents: Not including necessary supporting documents can weaken your application. Always attach the required proof of income and assets.

  7. Incorrect Contact Information: Providing an incorrect phone number or email address can hinder communication. Make sure your contact information is accurate.

  8. Not Following Instructions: Ignoring the specific instructions for filling out the form can lead to mistakes. Always read the guidelines carefully.

  9. Neglecting to Review: Skipping a final review before submission can lead to overlooked errors. Take the time to review your form thoroughly.

  10. Submitting Multiple Applications: Some individuals mistakenly submit multiple I-134 forms for the same beneficiary. This can create confusion and delays in processing.

What You Should Know About This Form

  1. What is the USCIS I-134 form?

    The USCIS I-134 form, also known as the Affidavit of Support, is a document used by individuals who are sponsoring a foreign national for a visa or green card. This form demonstrates that the sponsor has the financial means to support the immigrant and ensures that the immigrant will not become a public charge.

  2. Who needs to file the I-134 form?

    The I-134 form is typically required when a U.S. citizen or lawful permanent resident sponsors a foreign national for a non-immigrant visa, such as a tourist or student visa. It may also be needed for certain immigration processes, like family reunification.

  3. What information is required on the I-134 form?

    The form requests detailed information about the sponsor's financial situation, including income, assets, and household size. It also requires personal details about the sponsor and the individual being sponsored, such as their names, addresses, and relationship.

  4. Is there a fee to file the I-134 form?

    There is no filing fee for the I-134 form. However, sponsors should be aware that there may be other fees associated with the visa application process for the foreign national.

  5. How do I submit the I-134 form?

    The completed I-134 form can be submitted to the U.S. embassy or consulate where the foreign national is applying for their visa. It is important to follow the specific instructions provided by the embassy or consulate regarding submission methods.

  6. Can I submit the I-134 form online?

    Currently, the I-134 form must be submitted in paper format. Ensure that you have signed and dated the form before submission, as electronic submissions are not accepted at this time.

  7. What happens after I submit the I-134 form?

    Once the I-134 form is submitted, the consular officer will review it during the visa interview. The officer will assess the sponsor's financial capability to support the immigrant. If the form is accepted, it will support the visa application process.

  8. How long is the I-134 form valid?

    The I-134 form does not have a specific expiration date. However, it is advisable to submit a current form that reflects your current financial situation. If there are significant changes in your financial status, you may need to submit a new form.

  9. What if my financial situation changes after I submit the I-134 form?

    If your financial situation changes significantly after you have submitted the I-134 form, it is important to inform the U.S. embassy or consulate. Providing updated information can help ensure that the visa application process remains accurate and transparent.

  10. Can I use the I-134 form for multiple applicants?

    The I-134 form is specific to one applicant. If you are sponsoring multiple individuals, you will need to complete a separate I-134 form for each person. Each form must reflect the sponsor's financial capability to support each respective applicant.

USCIS I-134 Example

 

Affidavit of Support

USCIS

 

Department of Homeland Security

Form I-134

 

OMB No. 1615-0014

 

U.S. Citizenship and Immigration Services

Expires 02/28/2021

 

 

 

 

 

 

 

 

 

 

 

 

START HERE - Type or print in black ink.

Part 1. Information About You (the Sponsor)

Your Full Name

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

Other Names Used

List all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 7.

Additional Information.

2.a. Family Name

(Last Name)

2.b. Given Name

(First Name)

2.c. Middle Name

Sponsor's Mailing Address

(USPS ZIP Code Lookup)

 

 

3.a. In Care Of Name

3.b. Street Number

and Name

3.c. Apt. Ste. Flr.

3.d. City or Town

3.e. State

 

3.f. ZIP Code

 

 

 

3.g. Province

3.h. Postal Code

3.i. Country

4.Are your mailing address and physical address the same?

Yes No

If you answered "No" to Item Number 4., provide your physical address in Item Numbers 5.a. - 5.h.

Sponsor's Physical Address

5.a. Street Number

and Name

5.b. Apt. Ste. Flr.

5.c. City or Town

5.d. State

 

5.e. ZIP Code

 

 

 

5.f. Province

5.g. Postal Code

5.h. Country

Other Information

6.Date of Birth (mm/dd/yyyy)

7.a. Town or City of Birth

7.b. Country of Birth

8.Alien Registration Number (A-Number) (if any)

A-

9.U.S. Social Security Number (if any)

10.USCIS Online Account Number (if any)

Citizenship or Residency or Status

If you are not a U.S. citizen based on your birth in the United States, or a non-citizen U.S. national based on your birth in American Samoa (including Swains Island), answer the following as appropriate:

11.a. I am a U.S. citizen through naturalization. My Certificate of Naturalization number is

11.b. I am a U.S. citizen through parent(s) or marriage. My Certificate of Citizenship number is

Form I-134 02/13/19

Page 1 of 8

Part 1. Information About You (the Sponsor)

(continued)

11.c.

 

I derived my U.S. citizenship by another method.

 

 

(Provide an explain in Part 7. Additional

 

 

Information.)

11.d.

 

I am a lawful permanent resident of the

 

 

United States. My A-Number is

 

 

A-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.e.

 

I am a lawfully admitted nonimmigrant. My

 

 

Form I-94, Arrival-Departure Record Number is

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

I am

 

 

 

years of age and have resided in the United

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

States since (Date) (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 2. Information About the Beneficiary

This affidavit is executed on behalf of the following person:

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

2.Date of Birth (mm/dd/yyyy)

3. Gender Male Female

4.A-Number (if any)

A-

5.Country of Citizenship or Nationality

6.Marital Status

Single or Single, Never Married

Married

Divorced

Widowed

Legally Separated

Marriage Annulled

Other

7.Relationship to Sponsor

Beneficiary's Physical Address

8.a.

Street Number

 

 

 

 

 

and Name

 

 

 

 

 

 

 

Apt.

 

 

 

 

 

 

8.b.

Ste.

Flr.

 

 

8.c.

City or Town

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.d.

State

 

 

 

8.e.

ZIP Code

 

 

 

 

 

 

 

 

 

 

8.f.

Province

 

 

 

 

 

 

 

 

 

 

 

 

8.g.

Postal Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.h.

Country

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Beneficiary's Spouse (accompanying or following to join beneficiary)

9.a. Family Name

(Last Name)

9.b. Given Name

(First Name)

9.c. Middle Name

10.Date of Birth (mm/dd/yyyy)

11.Gender Male Female

Beneficiary's Children

Child 1

12.a. Family Name

(Last Name)

12.b. Given Name

(First Name)

12.c. Middle Name

13.Date of Birth (mm/dd/yyyy)

14.Gender Male Female

Child 2

15.a. Family Name

(Last Name)

15.b. Given Name

(First Name)

15.c. Middle Name

16.Date of Birth (mm/dd/yyyy)

17. Gender Male Female

If you need additional space to complete this section, use the

space provided in Part 7. Additional Information.

Form I-134 02/13/19

Page 2 of 8

Part 3. Other Information About the Sponsor

7.a. I have life insurance in the sum of $

Employment Information

I am currently:

1.a. Employed as a/an

1.a.1. Name of Employer (if applicable)

1.b.

Self employed as a/an

 

 

 

 

Current Employer Address (if employed)

2.a. Street Number

and Name

2.b. Apt. Ste. Flr.

2.c. City or Town

2.d. State

 

2.e. ZIP Code

 

 

 

2.f. Province

2.g. Postal Code

2.h. Country

Income and Asset Information

3. My annual income is

$

(If self-employed, I have attached a copy of my last income tax return or report of commercial rating concern which I certify to be true and correct to the best of my knowledge and belief. See Instructions for nature of evidence of net worth to be submitted.)

4.Balance of all my savings and checking accounts in United States-based financial institutions

$

5.Value of my other personal property

$

6.Market value of my stocks and bonds

$

I have listed my stocks and bonds in Part 7. Additional Information (or attached a list of them), which I certify to be true and correct to the best of my knowledge and belief.

7.b. With a cash surrender value of

$

Real Estate Information

8.a. I own real estate valued at

$

8.b. I have mortgages or other debts amounting to

$

My real estate is located at:

9.a. Street Number

and Name

9.b. Apt. Ste. Flr.

9.c. City or Town

9.d. State

 

9.e. ZIP Code

 

 

 

Dependents' Information

The following persons are dependent upon me for support. If you need extra space to complete this section, use the space provided in Part 7. Additional Information.

10.a. Family Name

(Last Name)

10.b. Given Name

(First Name)

10.c. Middle Name

11.Relationship to Me:

12.Date of Birth (mm/dd/yyyy)

13.This person is:

Wholly Dependent On Me For Support

Partially Dependent On Me For Support

14.a. Family Name

(Last Name)

14.b. Given Name

(First Name)

14.c. Middle Name

15.Relationship to Me:

16.Date of Birth (mm/dd/yyyy)

Form I-134 02/13/19

Page 3 of 8

Part 3. Other Information About the Sponsor

(continued)

17.This person is:

Wholly Dependent On Me For Support

Partially Dependent On Me For Support

18.a. Family Name

(Last Name)

18.b. Given Name

(First Name)

18.c. Middle Name

19.Relationship to Me:

20.Date of Birth (mm/dd/yyyy)

21.This person is:

Wholly Dependent On Me For Support

Partially Dependent On Me For Support

I have previously submitted affidavit(s) of support for the following person(s). (If none, write "None" in the space for name below.)

22.a. Family Name

(Last Name)

22.b. Given Name

(First Name)

22.c. Middle Name

23.Date Submitted (mm/dd/yyyy)

24.a. Family Name

(Last Name)

24.b. Given Name

(First Name)

24.c. Middle Name

25.Date Submitted (mm/dd/yyyy)

I have submitted a visa petition(s) to U.S. Citizenship and Immigration Services on behalf of the following persons. (If none, write “None” in the space for name below.)

26.a. Family Name

(Last Name)

26.b. Given Name

(First Name)

26.c. Middle Name

27.Relationship to Me:

28. Date of Birth (mm/dd/yyyy)

29. Date of Filing (mm/dd/yyyy)

30.a. Family Name

(Last Name)

30.b. Given Name

(First Name)

30.c. Middle Name

31.Relationship to Me:

32. Date of Birth (mm/dd/yyyy)

33. Date of Filing (mm/dd/yyyy)

34.a. Family Name

(Last Name)

34.b. Given Name

(First Name)

34.c. Middle Name

35.Relationship to Me:

36. Date of Birth (mm/dd/yyyy)

37. Date of Filing (mm/dd/yyyy)

38.I intend do not intend to make specific contributions to the support of the person(s) named in Part 2.

(If you select "intend," indicate the exact nature and duration of the contributions you intend to make in Part 7. Additional Information. For example, if you intend to furnish room and board, state for how long and, if money, state the amount in U.S. dollars and whether it is to be given in a lump sum, weekly or monthly, and for how long.)

Form I-134 02/13/19

Page 4 of 8

Part 4. Sponsor's Statement, Contact Information, Certification, and Signature

NOTE: Read the Penalties section of the Form I-134 Instructions before completing this part.

Sponsor's Statement

NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.

1.a.

I can read and understand English, and I have read and

 

understand every question and instruction on this

 

affidavit and my answer to every question.

1.b.

The interpreter named in Part 5. read to me every

 

question and instruction on this affidavit and my

 

answer to every question in

 

 

,

 

 

 

 

a language in which I am fluent and I understood

 

everything.

2.

At my request, the preparer named in Part 6.,

 

 

 

 

,

 

 

 

prepared this affidavit for me based only upon information I provided or authorized.

Sponsor's Contact Information

3.Sponsor's Daytime Telephone Number

4.Sponsor's Mobile Telephone Number (if any)

5.Sponsor's Email Address (if any)

Sponsor's Certification

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS or the Department of State may require that I submit original documents to USCIS or the Department of State at a later date. Furthermore, I authorize the release of any information from any of my records that USCIS or the Department of State may need to determine my eligibility for the immigration benefit I seek.

I further authorize release of information contained in this affidavit, in supporting documents, and in my USCIS or the Department of State records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws.

I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:

1)I reviewed and provided or authorized all of the information in my affidavit;

2)I understood all of the information contained in, and submitted with, my affidavit; and

3)All of this information was complete, true, and correct at the time of filing.

I certify, under penalty of perjury, that I provided or authorized all of the information in my affidavit, I understand all of the information contained in, and submitted with, my affidavit, and that all of this information is complete, true, and correct.

That this affidavit is made by me to assure the U.S. Government that the person named in Part 2. will not become a public charge in the United States.

That I am willing and able to receive, maintain, and support the person named in Part 2. I am ready and willing to deposit a bond, if necessary, to guarantee that such persons will not become a public charge during his or her stay in the United States, or to guarantee that the above named persons will maintain his or her nonimmigrant status, if admitted temporarily, and will depart prior to the expiration of his or her authorized stay in the United States.

That I understand that Form I-134 is an "undertaking" under section 213 of the Immigration and Nationality Act, and I may be sued if the persons named in Part 2. become a public charge after admission to the United States.

That I understand that Form I-134 may be made available to any Federal, State, or local agency that may receive an application from the persons named in Part 2. for Food Stamps, Supplemental Security Income, or Temporary Assistance to Needy Families.

That I understand that if the person named in Part 2. does apply for Food Stamps, Supplemental Security Income, or Temporary Assistance for Needy Families, my own income and assets may be considered in deciding the person's application. How long my income and assets may be attributed to the persons named in Part 2. is determined under the statutes and rules governing each specific program.

I acknowledge that I have read the section entitled Sponsor and Beneficiary Liability in the Instructions for this affidavit, and am aware of my responsibilities as a sponsor under the Social Security Act, as amended, and the Food Stamp Act, as amended.

Sponsor's Signature

6.a. Sponsor's Signature

6.b. Date of Signature (mm/dd/yyyy)

Form I-134 02/13/19

Page 5 of 8

NOTE TO ALL SPONSORS: If you do not completely fill out this affidavit or fail to submit required documents listed in the Instructions, USCIS or the Department of State may deny your affidavit.

Part 5. Interpreter's Contact Information, Certification, and Signature

Provide the following information about the interpreter.

Interpreter's Full Name

1.a. Interpreter's Family Name (Last Name)

1.b. Interpreter's Given Name (First Name)

2.Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address

3.a. Street Number

and Name

3.b. Apt. Ste. Flr.

3.c. City or Town

3.d. State

 

3.e. ZIP Code

 

 

 

3.f. Province

3.g. Postal Code

3.h. Country

Interpreter's Certification

I certify, under penalty of perjury, that:

 

I am fluent in English and

,

which is the same language provided in Part 4., Item Number 1.b., and I have read to this sponsor in the identified language every question and instruction on this affidavit and his or her answer to every question. The sponsor informed me that he or she understands every instruction, question, and answer on the affidavit, including the Sponsor's Certification, and has verified the accuracy of every answer.

Interpreter's Signature

7.a. Interpreter's Signature

7.b. Date of Signature (mm/dd/yyyy)

Part 6. Contact Information, Statement, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor

Provide the following information about the preparer.

Preparer's Full Name

1.a. Preparer's Family Name (Last Name)

1.b. Preparer's Given Name (First Name)

2.Preparer's Business or Organization Name (if any)

Interpreter's Contact Information

4.Interpreter's Daytime Telephone Number

5.Interpreter's Mobile Telephone Number (if any)

6.Interpreter's Email Address (if any)

Preparer's Mailing Address

3.a. Street Number

and Name

3.b. Apt. Ste. Flr.

3.c. City or Town

3.d. State

 

3.e. ZIP Code

 

 

 

3.f. Province

3.g. Postal Code

3.h. Country

Form I-134 02/13/19

Page 6 of 8

Part 6. Contact Information, Statement, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the

Sponsor (continued)

Preparer's Contact Information

4.Preparer's Daytime Telephone Number

5.Preparer's Fax Number

6.Preparer's Email Address (if any)

Preparer's Statement

7.a.

I am not an attorney or accredited representative but have prepared this affidavit on behalf of the sponsor and with the sponsor's consent.

7.b. I am an attorney or accredited representative and my representation of the sponsor in this case

extends does not extend beyond the preparation of this affidavit.

NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this affidavit, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application.

Preparer's Certification

By my signature, I certify, under penalty of perjury, that I prepared this affidavit at the request of the sponsor. The sponsor then reviewed this completed affidavit and informed me that he or she understands all of the information contained in, and submitted with, his or her affidavit, including the Sponsor's Certification, and that all of this information is complete, true, and correct. I completed this affidavit based only on information that the sponsor provided to me or authorized me to obtain or use.

Preparer's Signature

8.a. Preparer's Signature

8.b. Date of Signature (mm/dd/yyyy)

Form I-134 02/13/19

Page 7 of 8

Part 7. Additional Information

If you need extra space to provide any additional information within this affidavit, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this affidavit or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of each sheet; type or print the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.

5.a. Page Number 5.b. Part Number 5.c. Item Number

5.d.

Your Full Name

1.a.

Family Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Last Name)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.b.

Given Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(First Name)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.c.

Middle Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

A-Number (if any)

 

 

 

 

 

 

 

6.a. Page Number 6.b. Part Number 6.c. Item Number

 

 

 

A-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.a.

Page Number 3.b. Part Number

3.c. Item Number

6.d.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.d.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.a. Page Number 7.b. Part Number 7.c. Item Number

 

 

 

 

 

 

 

 

 

 

 

 

4.a. Page Number 4.b. Part Number

4.c. Item Number

7.d.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.d.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form I-134 02/13/19

Page 8 of 8