OMB No. 1615-0078; Expires 07/31/08 Department of Homeland Security U.S. Citizenship and Immigration Services
N-300, Application to File Declaration of Intention
For USCIS Use Only
Returned Receipt
START HERE - Please type or print in black ink. Part 1. Information about you. (NOTE: Applicant must complete
all three pages of this form.)
Family Name Address - C/O Street Number and Name City Country Date of Birth (mm/dd/yyyy) Country of Birth U.S. Social Security # (If any) Telephone Number A# (If any) E-Mail Address (If any) State or Province Zip/Postal Code Country of Citizenship Apt. # Given Name Middle Name
Resubmitted
Reloc Sent
Reloc Rec'd
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Part 2. Processing Information.
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. Read the information on penalties in the instructions before Part 3. Signature. completing this section. You must be in the United States when you file this application. You must sign your name below and also sign your name in the appropriate places (Signature of Applicant on Pages 2 and 3) of this form. 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 the U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking. Date Signature
Applicant Interviewed
Action Block
Part 4. Signature of person preparing form, if other than above. (Sign below.)
I declare that I prepared this application at the request of the above person and it is based on all information of which I have any knowledge. Signature Date Print Your Name Firm Name Firm Address To Be Completed by Attorney or Representative, if any Fill in box if G-28 is attached to represent the applicant. ATTY State License # Telephone Number E-Mail Address (If any) Form N-300 (Rev. 07/30/07)Y
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Original to be retained by USCIS - Duplicate to be given to:
Family Name Address - C/O Street Number and Name City Country Date of Birth (mm/dd/yyyy) Country of Birth U.S. Social Security # (If any) Telephone Number A# (If any) E-Mail Address (If any) State or Province Apt. # Given Name Middle Name
Affix Photograph
Zip/Postal Code Country of Citizenship
Here
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Not valid unless DHS Seal applied below.
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 pursuant to 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.
Signature of Applicant
Signature of Authorizing Official
Date
Date
Original Copy/Retained by USCIS
Form N-300 (Rev. 07/30/07)Y Page 2
Original to be retained by USCIS - Duplicate to be given to:
Family Name Address - C/O Street Number and Name City Country Date of Birth (mm/dd/yyyy) Country of Birth U.S. Social Security # (If any) Telephone Number A# (If any) E-Mail Address (If any) State or Province Apt. # Given Name Middle Name
Affix Photograph
Zip/Postal Code Country of Citizenship
Here
(
)
Not valid unless DHS Seal applied below.
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 pursuant to 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.
Signature of Applicant
Signature of Authorizing Official
Date
Date
Duplicate Copy/Given to Applicant
Form N-300 (Rev. 07/30/07)Y Page 3