DECLARATION OF <petitioner>
I, <petitioner>, residing <USA address>, do hereby declare as follows:
1. I was born in <>and am ___ years of age.
2. I am a lawful permanent resident/USC of the United States, and live in <city>.
3. As a lawful permanent resident, I had petitioned on <date of petiton> on Form I-130 for my son <>and the petition was approved on <>.
4. My son <applicant> was born on <>.
5. My son is about to apply for an immigrant visa at the U.S. Consulate in <where applicant is going to attend US visa interview>
6. I have, as required, prepared my affidavit of support on Form I-864 and am submitting to the National Visa Center.
7. With that I-864, I am unable to submit the tax returns for the last three years. The reason is that I am unemployed for each of those years and have no income. In view of this, I am not required to file and I have not filed any tax returns with the IRS or the Franchise Tax Board of the State of California.
8. My receipts from SSI are below the level at which I am required to file tax returns.
9. I have requested a relative,<whoever is your joint sponsor> to submit an I-864 form for the benefit of my said son <applicant>, which will be in addition to the one I am submitting herewith.
The above facts are within my personal knowledge and if called upon as a witness, I can and shall testify competently thereto.
I declare under penalty of perjury under the laws of the state of California and the laws of the United States of America that the foregoing is true and correct.
Executed on this ______ day of _____________ 2010 at <US city, State>.