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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...
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