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Signature of intending immigrant or of U.S. citizen parent if intending immigrant is less than 14 years old Date--mm/dd/yyyy Form I-864W 03/22/13 Y. Address Middle Name Street Number and Name include apartment number City State or Province Country This I-864W does not meet the requirements of exemption. Zip/Postal Code 3. Date of Birth mm/dd/yyyy 4. Country of Birth city/country 5. Telephone Number meets the Include area code or country and city codes Reviewer 6. Social Security Number if any...
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. S. citizen at birth, who is under 16 years of age, and is the intended spouse or parent of the citizen parent. Note: You may also be able to meet this claim if you have a valid Form I-130. A valid I-130 must show the child to be a lawful permanent resident. (3) Intending immigrant is a spouse or the child of a citizen, who is under 21 years of age and the intended child of the citizen parent. The citizen parent must have been born after December 31, 1991. (4) Intending immigrant is the unmarried son or daughter of a citizen who (1) died or was incarcerated as a result of a conviction for an aggravated felony or a violent felony, or (2) was discharged or released from military service, or (3) is a member of the United States Armed Forces or the National Guard and is not married or has no child. This requirement does not apply to any dependent child of the citizen parent. (5) Intending immigrant is a child under 18 years of age who was under 21 years of age on January 1, 2010, and was physically present legally or on a bona fide temporary (less than 2-year) basis (such as, in some cases, an authorized visit, stay of 90 days). The child's parent or unmarried guardian must be the principal beneficiary of the parent's plan to purchase or maintain self-employed health insurance coverage. (6) Intending immigrant is an unmarried child under 5 years of age, who is adopted by a citizen parent. The adopted child must be a citizen child not younger than 5 years of age on January 1, 2010, and must have been a student in public elementary or secondary school. The citizen parent may have been a student in public school for 5 years or more before the adoption. The adopted child may also have been an enrolled employee in a state education plan or a public or private vocational school. (7) Intending immigrant is a child who, before the adoption, was in foster or legal custody of a citizen parent and had been enrolled in or in a school during his or her entire kindergarten through third grade period, on or after the day before the birth of his or her legal adoptive parent, from kindergarten through the end of the day immediately preceding the adoption.
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