Online Request to be a Supporter and

USCIS
Declaration of Financial Support Form I-134A
Department of Homeland Security OMB No. 1615-0157
Expires 05/31/2024
U.S. Citizenship and Immigration Services

► START HERE - Type or print in black ink

Part 1. Basis for Filing
1. I am filing this form on behalf of: Myself as the beneficiary. Another individual who is the beneficiary.

2. I am filing this form under one of the following: Parole Process

If "Parole Process" selected in Item Number 2.

3. I am filing for an individual under the parole process for the following country Venezuela
If "Family Reunification Program" selected in Item Number 2.

4. I am filing for my relative who is associated with an approved Form I-130 and a national of :

5. Invitation Number:

6. How many total family members will be included in this family reunification group
who all share the same invitation number?

Part 2. Information about the Beneficiary

Complete Part 2. regardless of whether you are filing this form on behalf of yourself as the beneficiary or on behalf of another
individual who is the beneficiary.
1. Beneficiary's Current Legal Name (Do not provide a nickname.)

2. Other Names Used

Electronic
Family Name (Last Name)
garces
Given Name (First Name)
Valentina
Middle Name

del Carmen

Provide all other names the beneficiary has ever used, including aliases, maiden name, and nicknames. If you need extra space
to complete this section, use the space provided in Part 8. Additional Information.
Family Name (Last Name) Given Name (First Name) Middle Name

3.

4.
Form
If "Family Reunification Program" selected in Part 1., Item Number 2. Is this the individual listed as
the principal beneficiary in your Family Reunification Parole Process invitation letter? Yes

A grant of parole is a discretionary determination granted on a case-by-case basis for urgent humanitarian reasons or significant
public benefit. Please explain why a favorable exercise of discretion is merited for this individual.

As the father of the child in question, I am urgently requesting a grant of parole due to
No

Only
the critical
situation my daughter faces in Venezuela. Living with his elderly grandparents who are
struggling
with health issues, she lacks necessary care and supervision. Their advanced age and
5. Date of Birth (mm/dd/yyyy) 6. Sex 7. Alien Registration Number (A-Number)

08/02/2012 M F X ► A-

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 Part 2. Information about the Beneficiary (continued)
8. Place of Birth
City or Town State or Province
punto fijo falcon
Country
Venezuela
9. Country of Citizenship or Nationality
Venezuela
10. Passport Number of the beneficiary's most recently issued passport Country that issued the most recently issued passport

181271383 Venezuela
Expiration date for the most recently issued passport (mm/dd/yyyy) 08/28/2028

11. Marital Status

Single, Never Married Married Divorced Widowed Legally Separated Marriage Annulled
Other (Explain):

12. Beneficiary's Mailing Address

In Care Of Name

Street Number and Name Apt. Ste. Flr. Number

Maria auxiliadora street#2 home#56
City or Town
Punto fijo
Province
falcon
Electronic Postal Code
4102
13. Are the beneficiary's mailing address and physical address the same?

If you answered "No" to Item Number 13., provide your physical address in Item Number 14.
State

Country
Venezuela
ZIP Code

Yes No

Form
14. Beneficiary's Physical Address
In Care Of Name

Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.) Apt. Ste. Flr. Number

Maria auxiliadora street#2 home#56

City or Town State ZIP Code
Punto fijo
Province
falcon

Only
15. Beneficiary's Daytime Telephone Number

00584124542639
17. Beneficiary's Email Address (if any)
Postal Code
4102
Country
Venezuela

16. Beneficiary's Mobile Telephone Number (if any)

00584124542639

jennydegarces@gmail.com

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 Part 2. Information about the Beneficiary (continued)
Beneficiary's Anticipated Length of Stay
18. Beneficiary's Anticipated Period of Stay in the United States
From (mm/dd/yyyy) 08/22/2024

To (select one):

(mm/dd/yyyy) 08/22/2026

No End Date

Beneficiary's Financial Information

Provide information about the beneficiary's income and assets. If you need additional space to complete any Item Number in this
section, use the space provided in Part 8. Additional Information.

Beneficiary's Income

19. Provide all of the information requested in the table below about the beneficiary, all of the beneficiary's dependents, and any
other individuals the beneficiary financially supports (do not include any individuals named in Part 3.). Information about
assets that are not based on employment should be added in Item Number 24. and not in Item Number 19.

Relationship to the Beneficiary Income

Individual's Full Name (Type or print "Self" if you are filing for contribution to the
Date of Birth
(First, Middle, Last)(do not include any yourself as the beneficiary or beneficiary
(mm/dd/yyyy)
individuals named in Part 3.) "Beneficiary" if someone is agreeing to annually (if none,
support you in Part 3.) type or print $0)

Electronic $

Form Total Number of Dependents

20. Does any of the beneficiary's total income (including income from dependents and other
Total Income $

individuals who contribute to the beneficiary's income, excluding any individuals named in Part 3.)
$

Yes No

come from an illegal activity or source (such as proceeds from illegal gambling or illegal drug
sales)?

Only
21. If you answered "Yes" to Item Number 20., what amount of the beneficiary's total income comes
from an illegal activity or source? (Type or print "N/A" if you answered "No" to Item Number 20.)

22. Does any of the beneficiary's total income comes from means-tested public benefits as defined in
8 CFR 213a.1?

23. If you answered "Yes" to Item Number 22., what amount of the beneficiary's total income
$

$
Yes No

comes from means-tested public benefits?

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 Part 2. Information about the Beneficiary (continued)

Beneficiary's Assets

24. In the table below, provide the amounts of assets available to the beneficiary for the expected period of his or her stay
(excluding assets from any individuals named in Part 3.). Attach evidence showing that the beneficiary has these assets.

Full Name of Asset Holder Amount (Cash Value)

Type of Asset
(First, Middle, Last) (U.S. dollars)

TOTAL (U.S. dollars) $

Part 3. Information About the Individual Agreeing to Financially Support the Beneficiary Named in
Part 2.
If you are not the beneficiary named in Part 2., complete Part 3.

1. Current Legal Name (Do not provide a nickname.)

Family Name (Last Name) Given Name (First Name) Middle Name

Electronic
garces Anthony jose
2. Other Names Used
Provide 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 8. Additional Information.
Family Name (Last Name) Given Name (First Name) Middle Name

3.

4.
Form
If "Parole Process" selected in Part 1., Item Number 2. Provide the name of the organization, group, or individual that is
providing support to the beneficiary with you (if any)
Organization, Group, Individual Name

If "Family Reunification Program" selected in Part 1., Item Number 2. Provide the name of the individual co-supporter(s) joining
you to provide financial support to the beneficiary (if any)

Only
Individual Co-supporter(s) Name(s)

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 Part 3. Information About the Individual Agreeing to Financially Support the Beneficiary Named in
Part 2. (continued)
5. Current Mailing Address

In Care Of Name

Street Number and Name Apt. Ste. Flr. Number

410 andrew circle
City or Town State ZIP Code
GASTONIA NC 28056
Province Postal Code Country
United States

6. Is your current mailing address the same as your current physical address? Yes No

If you answered "No" to Item Number 6., provide your current physical address in Item Numbers 7.
7. Physical Address

In Care Of Name

Street Number and Name Apt. Ste. Flr. Number

410 andrew circle
City or Town State ZIP Code
GASTONIA
Province

Other Information
8.
Electronic
Date of Birth (mm/dd/yyyy) 08/22/1987
Postal Code

9. Sex M F
NC
Country
United States

X
28056

Form
10. Place of Birth

City or Town State or Province

punto fijo falcon

Country
Venezuela

Only
11. Alien Registration Number (A-Number) 12. USCIS Online Account Number

► A- 220859422 ► 035885754427
13. Social Security Number 14. What is your relationship to the beneficiary?

► 743296968 Daughter

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 Part 3. Information About the Individual Agreeing to Financially Support the Beneficiary Named in
Part 2. (continued)

Immigration Status
15. What is your current immigration status? Provide documentation as provided in the instructions.

U.S. Citizen
U.S. National
Lawful Permanent Resident
Nonimmigrant Form I-94 Arrival-Departure Record Number
►
Other (Explain):

TPS Approved

Employment Information
16. Employment Status

Employed (full-time, part-time, seasonal, self-employed) Unemployed or Not Employed Retired

Other (Explain):

If you indicated that you are employed in Item Number 16., provide the information requested in Item Numbers 17. - 18.

17. A. I am currently employed as a/an Name of Employer

Electronic
mechanic automotive tonys bear autoshop llc

B. I am currently self-employed as a/an

18. Current Employer's Address

Street Number and Name Apt. Ste. Flr. Number

Form
102 mariposa rd
City or Town State ZIP Code
stanley NC 28164
Province Postal Code Country
United States

Only
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 Part 3. Information About the Individual Agreeing to Financially Support the Beneficiary Named in
Part 2. (continued)

Financial Information
Provide information about your income and assets. If you need additional space to complete any Item Number in this section, use the
space provided in Part 8. Additional Information.

Income

19. Provide all of the information requested in the table below about yourself, all of your dependents, and any other individuals you
financially support (do not include any individuals named in Part 2.). Information about assets that are not based on
employment should be added in Item Number 24. and not in Item Number 19.

Income
Relationship to the Individual Agreeing
Full Name Contribution to the
Date of Birth to Financially Support (Type or print
(First, Middle, Last) (do not include any Beneficiary
(mm/dd/yyyy) "Self" for Individual Agreeing to
individuals named in Part 2.) Annually (if none,
Financially Support the Beneficiary)
type or print $0)

anthony jose garces 08/22/1987 Self $ $46,800.00

$
$
$
$
Total Number of Dependents 1
Total Income $ $46,800.00

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20. Does any of the income listed above come from an illegal activity or source (such as proceeds from Yes No
illegal gambling or illegal drug sales)?

21. If you answered "Yes" to Item Number 20., what amount of income comes from an illegal activity? $
(Type or print "N/A" if you answered "No" to Item Number 20.)
22. Does any of the income listed above come from means-tested public benefits as defined in 8 CFR Yes No
213a.1?

23. If you answered "Yes" to Item Number 22., what amount of income is from means-tested $
public benefits?

Assets

Form
24. Fill out the table below regarding the assets available to you (do not include any assets from any individuals named in Part 2.).
Attach evidence showing you have these assets.

Full Name of Asset Holder

(you or your household member)
anthony jose garces
Type of Asset

Checking - Bank Account

Amount (Cash Value)
(U.S. dollars)
$10,000.00

Only
anthony jose garces Personal Property (net value) $12,500.00
anthony jose garces Personal Property (net value) $4,000.00

TOTAL (U.S. dollars) $ $26,500.00

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 Part 3. Information About the Individual Agreeing to Financially Support the Beneficiary Named in
Part 2. (continued)

Financial Responsibility for Other Beneficiaries

25. Have you previously submitted a Form I-134A on behalf of a person other than the beneficiary Yes No
named in Part 2?

If you answered "Yes" to Item Number 25., provide the information requested in Item Numbers 26. - 27. If you need additional
space to complete this section, use the space provided in Part 8. Additional Information.

26. Person 1
Family Name (Last Name) Given Name (First Name) Middle Name

garces Santiago alessandro

A-Number Date Submitted (mm/dd/yyyy)

► A- 06/18/2011

27. Person 2
Family Name (Last Name) Given Name (First Name) Middle Name

garces Juan manuel

A-Number Date Submitted (mm/dd/yyyy)

► A- 07/15/2019

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Intent to Provide Specific Contributions to the Beneficiary
28. You are responsible for receiving, maintaining, and supporting the beneficiary for the duration of their temporary stay in the
United States. Describe the resources you plan to use or provide to ensure the beneficiary has adequate financial support to
cover their basic living needs.

The beneficiary will have the support of my income for all his needs. You will live
in our house and i will have my time for everything you need in your days during your

Form
stay in the United States

29. You are responsible for ensuring that the beneficiary has safe and appropriate housing for the duration of their parole in the
United States. Describe how you will ensure that the beneficiary's housing needs are met, including where the beneficiary will
reside during their temporary stay in the United States, if known.

The beneficiary will have a safe stay in my house, which is located in a safe and

Only
supportive neighborhood. During their time in this country, I will make sure to
prepare and care for the house as safe as possible for their well-being. They will
have a room with everything they need. meet your needs

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 Part 3. Information About the Individual Agreeing to Financially Support the Beneficiary Named in
Part 2. (continued)
30. You are responsible for assisting the beneficiary's access to available services and benefits such as learning English, securing
employment opportunities once authorized to work, enrolling children in school, and helping to enroll for benefits for which
they are eligible. Describe what steps you plan to take as part of these responsibilities.

I will help my son, the beneficiary, learn English or enroll him in English courses
and enroll him in a school for his learning in addition to providing him with health
insurance and other arguments that lead to adequate training in this country.

Part 4. Statement, Contact Information, Certification, and Signature of the Beneficiary (Only complete
this section if Part 1. Basis for Filing selection is "Myself as the beneficiary", otherwise continue to Part
5.)
If you are the beneficiary and are filing Form I-134A on your own behalf, complete and sign Part 4.
NOTE: Read the Penalties section of the Form I-134A Instructions before completing this section.

Beneficiary's Statement
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.

1.

B. Electronic
I, as the beneficiary, certify the following:

A. I can read and understand English, and I have read and understand every question and instruction on this declaration
and my answer to every question.
The interpreter named in Part 6. read to me every question and instruction on this declaration and my answer to every
question in
everything.
, a language in which I am fluent and I understood

2. At my request, the preparer named in Part 7., , prepared

Form
this declaration for me based only upon information I provided or authorized.

Beneficiary'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 and all of my records that USCIS or the Department of State may need to determine
my eligibility for the immigration benefit I seek.

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I further authorize release of information contained in this declaration, 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 declaration;

2) I understood all of the information contained in, and submitted with, my declaration; and
3) All of this information was complete, true, and correct at the time of filing.

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 Part 4. Statement, Contact Information, Certification, and Signature of the Beneficiary (Only complete
this section if Part 1. Basis for Filing selection is "Myself as the beneficiary", otherwise continue to Part
5.) (continued)
I certify, under penalty of perjury, that I provided or authorized all of the information in my declaration, I understand all of the
information contained in, and submitted with, my declaration, and that all of this information is complete, true, and correct.

That this declaration is made by me to assure the U.S. Government that I will be able to financially support myself while in the United
States.

That I am willing and able to pay for necessary expenses for the duration of my temporary stay in the United States.

Beneficiary's Signature
3. Beneficiary's Signature Date of Signature (mm/dd/yyyy)

➡
Part 5. Statement, Contact Information, Certification, and Signature of the Individual Agreeing to
Financially Support the Beneficiary
If you are filing Form I-134A on behalf of someone else (the beneficiary listed in Part 2.), complete and sign Part 5.

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

Statement of Individual Agreeing to Financially Support the Beneficiary

NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.

1. I, as the individual agreeing to financially support the beneficiary, certify the following:

Electronic
A. I can read and understand English, and I have read and understand every question and instruction on this declaration
and my answer to every question.
B. The interpreter named in Part 6. read to me every question and instruction on this declaration 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 7., , prepared

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

(704) 308-8257 Form

Contact Information of Individual Agreeing to Financially Support the Beneficiary
3. Daytime Telephone Number

5. Email Address (if any)

garciesanth@gmail.com
4. Mobile Telephone Number (if any)

(704) 308-8257

Only
Certification of Individual Agreeing to Financially Support the Beneficiary
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 and all 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 declaration, 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 law.

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 Part 5. Statement, Contact Information, Certification, and Signature of the Individual Agreeing to
Financially Support the Beneficiary (continued)
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 declaration;

2) I understood all of the information contained in, and submitted with, my declaration; 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 declaration, I understand all of the
information contained in, and submitted with, my declaration, and that all of this information is complete, true, and correct.

That this declaration is made by me to assure the U.S. Government that the person named in Part 2. will be financially supported
while in the United States.

That I am willing and able to receive, maintain, and support the person named in Part 2. to better ensure that such persons will have
sufficient financial resources or financial support to pay for necessary expenses for the period of his or her temporary stay in the
United States.

I acknowledge that I have read this section, and I am aware of my responsibilities as an individual agreeing to financially support the
beneficiary.

Signature of Individual Agreeing to Financially Support the Beneficiary

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

➡
NOTE TO ALL INDIVIDUALS AGREEING TO FINANCIALLY SUPPORT THE BENEFICIARY: If you do not completely

Electronic
fill out this declaration or if you fail to submit required documents listed in the instructions, USCIS or the Department of State may
deny or not consider your declaration.

Part 6. Interpreter's Contact Information, Certification, and Signature

Provide the following information about the interpreter.

Interpreter's Full Name

1. Interpreter's Family Name (Last Name) Interpreter's Given Name (First Name)

2.

Form
Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address

3. Street Number and Name Apt. Ste. Flr. Number

City or Town

Province
Only Postal Code
State

Country
ZIP Code

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 Part 6. Interpreter's Contact Information, Certification, and Signature (continued)

Interpreter's Contact Information

4. Interpreter's Daytime Telephone Number 5. Interpreter's Mobile Telephone Number

6. Interpreter's Email Address (if any)

Interpreter's Certification
I certify, under penalty of perjury, that:

I am fluent in English and which is the same language specified in Part 4.

or in Part 5., Item B. in Item Number1., and I have read to this individual agreeing to financially support the beneficiary in the
identified language every question and instruction on this declaration and his or her answer to every question. The individual agreeing
to financially support the beneficiary informed me that he or she understands every instruction, question, and answer on the
declaration, including the Certification of the Individual Agreeing to Financially Support the Beneficiary, and has verified the
accuracy of every answer.

Interpreter's Signature
7. Interpreter's Signature Date of Signature (mm/dd/yyyy)

Electronic
Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Declaration, if
Other Than the Individual Agreeing to Financially Support the Beneficiary

Provide the following information about the preparer.

Preparer's Full Name

1. Preparer's Family Name (Last Name) Preparer's Given Name (First Name)

2.

3.
Form
Preparer's Business or Organization Name (if any)

Preparer's Mailing Address

Street Number and Name Apt. Ste. Flr. Number

City or Town

Province
Only Postal Code
State

Country
ZIP Code

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 Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Declaration, if
Other Than the Individual Agreeing to Financially Support the Beneficiary (continued)

Preparer's Contact Information

4. Preparer's Daytime Telephone Number 5. Preparer's Mobile Telephone 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 declaration on behalf of the individual agreeing
to financially support the beneficiary (which is the beneficiary if filing on behalf of him or herself) and with that
individual's consent.

B. I am an attorney or accredited representative and my representation of the individual agreeing to financially support the
beneficiary (which is the beneficiary if filing on behalf of him or herself) in this case extends does not extend
beyond the preparation of this declaration.

NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative, with this application.

Preparer's Certification

Electronic
By my signature, I certify, under penalty of perjury, that I prepared this declaration at the request of the individual agreeing to
financially support the beneficiary (which is the beneficiary if filing on behalf of him or herself). The individual agreeing to
financially support the beneficiary (which is the beneficiary if filing on behalf of him or herself) then reviewed this completed
declaration and informed me that he or she understands all of the information contained in, and submitted with, his or her declaration,
including the Certification of the Individual Agreeing to Financially Support the Beneficiary, and that all of this information is
complete, true and correct. I completed this declaration based only on information that the individual agreeing to financially support
the beneficiary provided to me or authorized me to obtain or use.

Preparer's Signature

Form
8. Preparer's Signature Date of Signature (mm/dd/yyyy)

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 Evidence Submitted

File Name Document Category

DOCUMEN THE CAR 2.pdf Financial

Tax 2023 Anthony Garces (1).PDF Financial

BANK STATEMENT.pdf Financial

CO SPONSOR BANK 2.pdf Financial

Escaner 3.pdf Financial

carta de trabajo SPONSOR.pdf Employment

EIN MY COMPANY.pdf Financial

TPS Approval with I-94.pdf Immigration Status

Electronic
CO SPONSOR BANK.pdf Financial

CARTA DE TRABAJO (2).pdf Employment

Tonys Autoshop .pdf Financial

BANK STATEMENT 2.pdf Financial

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Previously Submitted I-134A Beneficiaries

Family Name (Last Name) Given Name (First Name) Middle Name

de Garces Jenny alicia

A-Number Date Submitted (mm/dd/yyyy)

► A- 08/21/1970

Family Name (Last Name) Given Name (First Name) Middle Name

Garces Manuel antonio

A-Number Date Submitted (mm/dd/yyyy)

► A- 04/24/1965

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Form I-134A Edition 11/16/23 Electronic Form Only Page 15 of 15
 Additional Information ► A- 220859422

Department of Homeland Security

Please provide an explanation.:

I also want to add in this explanatory letter that my 2023 taxes were submitted with my ITIN number 984 97 1774 since at that
time it was not assigned a social security number as I currently have it, my SSN new 743 29 6968

I am currently managing my own workshop since this year and I have the financial capacity to provide all the basic needs of my
beneficiary, in addition to having the support of my spouse, my brother and the mother of my daughter

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