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Misconceptions

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

  • Misconception 1: The I-134 is a legally binding contract.
  • This form is not a legally binding contract. It is a declaration of financial support, but it does not create enforceable obligations.

  • Misconception 2: Only U.S. citizens can fill out the I-134.
  • While U.S. citizens commonly use this form, lawful permanent residents can also submit the I-134 to support a visa applicant.

  • Misconception 3: The I-134 guarantees visa approval.
  • Submitting the I-134 does not guarantee that a visa will be granted. It is just one part of the overall application process.

  • Misconception 4: The I-134 is only for family members.
  • This form can be used to support friends or other individuals, not just family members. The key is demonstrating financial capability.

  • Misconception 5: You must have a high income to complete the I-134.
  • While having a sufficient income is important, the I-134 can be completed by individuals with various income levels, provided they can show they can support the applicant.

  • Misconception 6: The I-134 must be notarized.
  • Notarization is not a requirement for the I-134 form. However, it can add credibility to the document.

  • Misconception 7: The I-134 is the only form needed for sponsorship.
  • The I-134 is just one form. Depending on the situation, additional forms or documents may be necessary to complete the sponsorship process.

Steps to Writing USCIS I-134

After you have gathered all necessary information, you are ready to begin filling out the USCIS I-134 form. Completing this form accurately is essential, as it plays a key role in supporting your application. Follow these steps to ensure you fill it out correctly.

  1. Start with the applicant's information. Provide your full name, address, and contact details in the designated sections.
  2. Next, move on to the information about the beneficiary. Include their full name, date of birth, and country of origin.
  3. In the section for employment information, list your current employer, job title, and annual income. If you have multiple sources of income, include them as well.
  4. Provide details about your assets. This includes bank account balances, property, and any other significant assets you own.
  5. Complete the section regarding household information. List the number of people living in your household and their relationship to you.
  6. Sign and date the form at the bottom. Make sure your signature is clear and matches the name you provided at the beginning.
  7. Finally, review the entire form for accuracy. Ensure all sections are filled out completely and check for any typos or errors.

Once you have completed the form, you can submit it along with any required supporting documents to the appropriate USCIS address. Make sure to keep a copy for your records!

Common mistakes

Completing the USCIS I-134 form can be a daunting task. Many individuals make common mistakes that can delay the process or even lead to denials. One frequent error is failing to provide accurate personal information. It’s crucial to ensure that names, addresses, and dates of birth are entered correctly. Even a small typo can cause significant issues.

Another common mistake is not including the required supporting documents. The I-134 form requires proof of income and financial stability. Applicants often forget to attach pay stubs, tax returns, or bank statements. Omitting these documents can result in a request for additional evidence, prolonging the application process.

Many people also overlook the importance of signatures. Each section that requires a signature must be completed. An unsigned form is considered incomplete and will be rejected. Double-checking for signatures can save time and prevent unnecessary delays.

Using outdated versions of the form is another mistake applicants make. USCIS updates forms periodically, and using an old version can lead to complications. Always ensure you are using the most current form available on the USCIS website.

Providing insufficient information about the sponsor’s financial situation can also be problematic. The I-134 form asks for detailed financial information. Incomplete or vague answers may raise red flags for USCIS. Clarity and thoroughness are essential.

Some applicants forget to review the form for errors before submission. Simple mistakes, such as incorrect calculations or missing fields, can have serious consequences. A careful review can catch these errors and improve the chances of approval.

In addition, many people fail to keep copies of their submitted forms. Retaining a copy is important for future reference. If questions arise or if there is a need to follow up, having a copy can be invaluable.

Another mistake involves misunderstanding the purpose of the I-134 form. This form is not a guarantee of visa approval. It is a declaration of financial support. Misunderstanding its function can lead to unrealistic expectations.

Lastly, applicants sometimes submit the form without fully understanding the financial obligations involved. The sponsor must be prepared to support the applicant financially. Failing to recognize this responsibility can lead to complications down the road.

Form Data

Fact Name Details
Purpose The USCIS I-134 form is used as an Affidavit of Support for non-immigrant visa applicants.
Eligibility Individuals seeking to sponsor a non-immigrant must demonstrate sufficient financial resources.
Filing Requirement The form must be submitted along with the visa application to prove financial support.
Supporting Documents Sponsors should provide evidence of income, assets, and tax returns to support the affidavit.
Legal Binding By signing the form, the sponsor commits to financially support the visa applicant.
Validity Period The I-134 remains valid as long as the non-immigrant visa is active and the sponsor's financial situation remains stable.
State-Specific Forms No state-specific forms are required; the I-134 is governed by federal law.
Common Mistakes Incomplete forms or lack of supporting documentation can lead to delays or denials.
Submission Method The form can be submitted online or via mail, depending on the specific visa application process.

Frequently Asked Questions

  1. What is the USCIS I-134 form?

    The USCIS I-134 form, also known as the Affidavit of Support, is a document that a U.S. citizen or lawful permanent resident can submit to show that they can financially support a foreign national. This form is often used when someone is applying for a visa or adjusting their status in the U.S. The purpose is to demonstrate that the foreign national will not become a public charge, meaning they will not rely on government assistance.

  2. Who needs to fill out the I-134 form?

    Typically, the I-134 form is filled out by a sponsor, who is usually a family member or friend of the foreign national. The sponsor must be a U.S. citizen or a lawful permanent resident and must have sufficient income or assets to support the applicant. This form is often required for visa applications such as tourist visas or for family members seeking to join relatives in the U.S.

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

    The I-134 form requires detailed information about the sponsor, including:

    • Name and address
    • Employment details
    • Income and financial resources
    • Information about the foreign national being sponsored

    It’s important to provide accurate and truthful information, as any discrepancies could affect the application process.

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

    The I-134 form can be submitted online or by mail, depending on the specific instructions for the visa application. If submitting by mail, ensure that you send it to the correct address as indicated by USCIS. It’s also a good idea to keep a copy of the completed form for your records.

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

    Once the I-134 form is submitted, USCIS will review it along with the visa application. They may contact the sponsor for additional information or documentation. If everything is in order, the foreign national will be one step closer to obtaining their visa. However, approval is not guaranteed, as it depends on the overall application and eligibility.

Documents used along the form

The USCIS I-134 form, also known as the Affidavit of Support, is often accompanied by several other important documents that help establish a financial basis for a visa applicant. These documents provide additional evidence of the sponsor's ability to support the individual seeking a visa. Below is a list of commonly used forms and documents that complement the I-134.

  • Form I-130: This is the Petition for Alien Relative. It is filed by a U.S. citizen or lawful permanent resident to establish a family relationship with a foreign national who wishes to immigrate to the United States.
  • Form I-864: Known as the Affidavit of Support Under Section 213A of the Act, this form is similar to the I-134 but is typically used for family-based immigration cases. It requires the sponsor to demonstrate their financial capability to support the immigrant.
  • Tax Returns: Providing copies of recent tax returns helps verify the sponsor's income. This document shows the financial resources available to support the visa applicant.
  • Employment Verification Letter: This letter, usually from the sponsor's employer, confirms employment status and salary. It serves as proof of income and stability.
  • Bank Statements: Recent bank statements can illustrate the sponsor's financial health. These documents provide a snapshot of available funds and overall financial responsibility.

When preparing the I-134 form, including these additional documents can strengthen the application. They collectively demonstrate the sponsor's commitment and ability to support the visa applicant during their stay in the United States.

Document Sample

 

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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