Affidavit of Support

I James Smith, residing at 8 Hayes St, San Rafael, CA 94901, certify under penalty of perjury that I was born on February 06, 1985 at CA and as follows: This affidavit is executed on behalf of the following person: Citizen of: United States Marital Status: Single Relationship to Sponsor:Friend Current Address: 123 H St City: San Rafael State: California Country: United States Name of spouse and children accompanying or following to join person: Spouse Susan Garcia Gender Female Child: Johnny Gender: Male Age 26 Age: 2

I am willing and able to provide financial support for the person on whose behalf this affidavit is executed. This affidavit is made by me for the purpose of assuring the CA Government that the person(s) named above will not become a public charge in CA. Oath or Affirmation of Sponsor: I certify under penalty of perjury under California law that I know the contents of this affidavit signed by me and that the statements are true and correct.

___________________________________ James Smith STATE OF CALIFORNIA COUNTY OF Marin County

_____________________________ Date

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On ____________________ before me, ________________________________, personally appeared James Smith, proved to me on the basis of satisfactory evidence to be the person(s) whose name is subscribed to the within Affidavit and acknowledged to me that he/she executed the same in his/her authorized capacity, and who, being first duly sworn on oath according to law, deposes and says that he/she has read the foregoing Affidavit subscribed by him/her, and that the matters stated herein are true to the best of his/her information, knowledge and belief. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal.

________________________________________ (Notary Seal) Signature of Notary Public

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