Official Federal Forms > US Citizenship And Immigration Services
Application To Preserve Residence For Naturalization Purposes N-470 - Official Federal Forms
| Application To Preserve Residence For Naturalization Purposes 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. 1615-0056; Expires 01/31/2016 Department of Homeland Security U.S. Citizenship and Immigration Services Form N-470, Application to Preserve Residence for Naturalization Purposes 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-470. Part 1. Information About Your Eligibility (check only one) My absence from the United States is on behalf of: 1. 2. 3. 4. The U.S. Government (employed by, or are under contract with, the U.S. Government). An American institution of research to perform scientific research. An American firm or corporation, or a subsidiary thereof, to engage in the development of foreign trade and commerce of the United States. An American firm or corporation to protect the property rights outside the United States of that American firm or corporation engaged in the development of foreign trade and commerce of the United States. A public international organization of which the United States is a member. (Your employment must have started after your admission as a permanent resident) A denomination or mission having a bona fide organization in the United States in which I perform ministerial or priestly functions or my sole capacity is of a clergyman or clergywoman, missionary, brother, nun or sister. Your A-Number: A - - For USCIS Use Only Bar Code Date Stamp 5. Remarks 6. Part 2. Information About You 1. Current Legal Name (do not provide a nickname) Family Name (last name) Given Name (first name) Middle Name (if applicable) 2. Your name exactly as it appears on your Permanent Resident Card Family Name (last name) Given Name (first name) Middle Name (if applicable) 3. U.S. Social Security Number (if any) 4. Date of Birth (mm/dd/yyyy) 5. Country of Birth 6. Country of Nationality Action 7. Home Address Street Number and Name (do not write a P.O. Box in this space unless it is your ONLY address.) City Province (foreign address only) County State Country (foreign address only) Apartment Number ZIP Code Postal Code (foreign address only) Form N-470 01/03/13 N Page 1 American LegalNet, Inc. www.FormsWorkFlow.com Part 2. Information About You (Continued) 8. Mailing Address C/O (in care of name) Street Number and Name City Province (foreign address only) State Country (foreign address only) Work Phone Number (if any) A - - Apartment Number ZIP Code Postal Code (foreign address only) 9. Daytime Phone Number Evening Phone Number ( ( ) ) ( ) ( ) Mobile Phone Number (if any) 10. E-Mail Address (if any) 11. Date you became a Permanent Resident (mm/dd/yyyy) 12. Have you resided in and been physically present in the United States for an uninterrupted period of at least 1 year since your admission as a permanent resident? (If you answer "No" you must provide an explanation on a separate sheet(s) of paper.) Yes No 13. Time Outside the United States (include trips to Canada, Mexico, and the Caribbean) List below all the trips of 24 hours or more that you have taken outside the United States since you became a permanent resident. Begin with your most recent trip. If you need more space, use an additional sheet(s) of paper. Date You Left the United States (mm/dd/yyyy) Date You Returned to the United States (mm/dd/yyyy) Did Trip Last 6 Months or More? Yes No Yes No Yes No Yes No Yes No 14. Explain your employment position requiring your absence from the United States and the intended length of employment. Countries You Traveled To Total Days Outside the United States 15. Have you ever filed an income tax return as a nonresident or otherwise claimed or received benefits as a nonresident alien under U.S. Federal, State or local income tax laws since you became a permanent resident? Yes No Form N-470 01/03/13 N Page 2 American LegalNet, Inc. www.FormsWorkFlow.com Part 3. Information About Family Members Who Reside With You A - Yes No 1. Do you have permanent resident family members who reside with you inside the United States? Yes No 2. Will those family members reside with you outside the United States? If you answered "Yes," provide the information below for each permanent resident family member who will be residing with you outside the United States. If you need more space, use an additional sheet(s) of paper. Given Name (first name) Middle Name (if applicable) A. Family Name (last name) Date of Birth (mm/dd/yyyy) B. Family Name (last name) Date of Birth (mm/dd/yyyy) C. Family Name (last name) Date of Birth (mm/dd/yyyy) Relationship to You Given Name (first name) Relationship to You Given Name (first name) Relationship to You A-Number Middle Name (if applicable) A-Number Middle Name (if applicable) A-Number Instructions if you are completing your Form N-470 electronically: To list additional family members, click the "Add Family Members" button and then click the "Go to Continuation Page" button. Go To Continuation Page Add Family Members Part 4. Your Signature (USCIS will reject your Form N-470 if it is not signed.) 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 the release of any information from my records that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit sought. Your Signature Date (mm/dd/yyyy) Part 5. Signature of Person Who Prepared This Form N-470 for You (if applicable) I declare under the penalty of perjury that I prepared this application at the request of the above person. Preparer's Printed Name Preparer's Firm or Organization Name (if applicable) Preparer's Address Street Number and Name City Province (foreign address only) Preparer's E-Mail Address (if any) County State Country (foreign address only) ZIP Code Postal Code (foreign address only) Preparer's Fax Number Preparer's Signature Date (mm/dd/yyyy) Preparer's Daytime Phone Number ( ) ( ) Form N-470 01/03/13 N Page 3 American LegalNet, Inc. www.FormsWorkFlow.com Continuation Page If you answered "Yes," provide the information below for each permanent resident family member who will be residing with you outside the United States. If you need more space, use an additional sheet(s) of paper. Given Name (first name) Relationship to You D. Family Name (last name) Date of Birth (mm/dd/yyyy) Middle Name (if applicable) A-Number E. Family Name (last name) Date of Birth (mm/dd/yyyy) Given Nam
|
|||||||
