Official Federal Forms > US Citizenship And Immigration Services
Application To File Declaration Of Intention N-300 - Official Federal Forms
| Application To File Declaration Of Intention Form. This is a national form and can be used in US Citizenship And Immigration Services . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
OMB No. 1615-0078; Expires 03/31/2016 Department of Homeland Security U. S. Citizenship and Immigration Services Form N-300, Application to File Declaration of Intention Print or type all your answers fully and accurately in black ink. Write "N/A" if an item is not applicable. Write "None" if the answer is none. Failure to answer all of the questions may delay your Form N-300. NOTE: You must complete all portions of the form (four pages). Part 1. Information About You 1. Current Legal Name (do not provide a nickname) Family Name (last name) Given Name (first name) Middle Name (if applicable) Your A-Number: A - - For USCIS Use Only Bar Code Date Stamp 2. U.S. Social Security Number (if any) 3. Date of Birth (mm/dd/yyyy) Remarks 4. Country of Birth 5. Date You Became a Permanent Resident (mm/dd/yyyy) Since you were admitted to the United States as a permanent resident, have you been absent for a period of six months or longer? No Yes Attach a list of departure/arrival dates of all absences. 6. Country of Nationality 7. Home Address Street Number and Name (do not provide a P.O. Box in this space unless it is your ONLY address.) Apartment Number County ZIP Code City State Action 8. Mailing Address C/O (in care of name) Street Number and Name Apartment Number City State ZIP Code Form N-300 (03/21/13) N American LegalNet, Inc. www.FormsWorkFlow.com Part 1. Information About You (Continued) 9. Daytime Phone Number Work Phone Number (if any) A - - Evening Phone Number ( ( ) ) ( ) ( ) Mobile Phone Number (if any) 10. E-Mail Address (if any) Part 2. Your Signature (USCIS will reject your Form N-300 if it is not signed.) Read the information on penalties in the instructions before completing this section. You must be in the United States when you file this application. You must sign your name below as well as in Part 4 and Part 5. I desire to declare my intention to become a citizen of the United States. I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with it is all true and correct. I authorize release of any information from my records that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking. Your Signature Date (mm/dd/yyyy) Part 3. Signature of Person Who Prepared This Form for You (if applicable) I declare under penalty of perjury that I prepared this form at the request of the above person, and it is based on all information of which I have any knowledge. Preparer's Printed Name Preparer's Signature Date (mm/dd/yyyy) Preparer's Firm or Organization Name (if applicable) Preparer's Daytime Phone Number ( Preparer's Address Street Number and Name ) City County State ZIP Code Preparer's E-Mail Address (if any) Preparer's Fax Number ( ) Form N-300 (03/21/13) N Page 2 American LegalNet, Inc. www.FormsWorkFlow.com Part 4. Declaration of Intent 1. Current Legal Name (do not provide a nickname) Family Name (last name) Given Name (first name) Middle Name (if applicable) A - - Affix Photograph 2. U.S. Social Security Number (if any) 4. Country of Birth 3. Date of Birth (mm/dd/yyyy) Here 5. Date You Became a Permanent Resident (mm/dd/yyyy) Not valid unless DHS Seal applied below. 6. Country of Nationality 7. Home Address Street Number and Name (do not provide a P.O. Box in this space) City 8. Mailing Address C/O (in care of name) Street Number and Name City 9. Daytime Phone Number State Work Phone Number (if any) ZIP Code Evening Phone Number County State Apartment Number ZIP Code Apartment Number ( ( ) ) ( ) ( ) Mobile Phone Number (if any) 10. E-Mail Address (if any) I am over the age of 18 years, have been lawfully admitted to the United States as a permanent resident, and am now residing in the United States based on such admission. I hereby declare my intention in good faith to become a citizen of the United States and I certify that the photographs affixed to the original and duplicate hereof are a likeness of me and were signed by me. I do swear (or affirm) that the statements I have made and the intentions I have expressed in this declaration of intention subscribed by me are true to the best of my knowledge and belief. Your Signature (USCIS will reject your Form N-300 if it is not signed) USCIS Officer's Signature Date (mm/dd/yyyy) Date (mm/dd/yyyy) Form N-300 (03/21/13) N Page 3 Original Mailed to Applicant/Copy to File American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
