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April 26, 2017
Document Cover Sheet
This cover sheet is for case HCM2009845083.When you send your documents to us, place them in the order
shown below, and put this cover sheet on top. Mark the checkbox [ X ] under Enclosedif you are sending the
document. Mark the checkbox [ X ] under Unavailableif you cannot obtain the document, and include a formal
statement explaining why it is unavailable. Mark the checkbox [ X ] under Not Applicableif the document is not
applicable or not needed for your case.
Order Document Enclosed Unavailable Not Applicable
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1. Document Cover Sheet................................ [ ]
2. Photocopiesof Supporting Documents:
Valid, unexpired passport..................... [ ] [ ] [ ]
Birth Certificate with translation.......... [ ] [ ] [ ]
Adoption Documentation...................... [ ] [ ] [ ]
Marriage Certificate with translation.... [ ] [ ] [ ]
Marriage Termination with translation. [ ] [ ] [ ]
Court Records with translation..............[ ] [ ] [ ]
Military Records with translation......... [ ] [ ] [ ]
Police Certificate(s) with translation.... [ ] [ ] [ ]
3. Signed Affidavit of Support(s).................... [ ] [ ] [ ]
Proof of U.S. Status.............................. [ ] [ ] [ ]
Proof of Domicile................................. [ ] [ ] [ ]
Petitioner's Civil Documents................. [ ] [ ] [ ]
Proof of relationship (only for I-864A) [ ] [ ] [ ]
Evidence of Income.............................. [ ] [ ] [ ]
Form(s) W-2......................................... [ ] [ ] [ ]
IRS Tax Transcript............................... [ ] [ ] [ ]
Federal Income Tax Returns................ [ ] [ ] [ ]
Social Security Earnings Statement...... [ ] [ ] [ ]
Proof of Assets...................................... [ ] [ ] [ ]
4. Other Supporting Documents.......................[ ] [ ] [ ]
If you have not submitted Form DS-260 Online Immigrant Visa and Alien Registration Application at
ceac.state.gov, please do so now. We cannot forward your petition to a U.S. Embassy overseas until you submit
Form DS-260. Also, only send photocopiesof your civil documents (e.g., birth certificate). Send a signed Form
I-864 Affidavit of Support(s). Do not send documents on any form of electronic media, such as memory cards.
F4
HCM2009845083
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