Form N-470 Application to Preserve Residence for Naturalization

OMB No. 1615-0056; Expires 01/31/2012

Form N-470, Application to Preserve
Residence for Naturalization Purposes

Department of Homeland Security
U.S. Citizenship and Immigration Services

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.
Your A-Number:

Part 1. Information About Your Eligibility (check only one)
1.
2.
3.
4.

5.

6.

-

A

My absence from the United States is on behalf of:
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.

-

For USCIS Use Only
Bar Code

Date Stamp

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.

DRAFT
NOT
FOR
PRODUCTION
A public international organization of which the United States is a member.
(Your employment must have started after your admission as a permanent
resident)

Remarks

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.

Part 2. Information About You

1. Current Legal Name (do not provide a nickname)
Family Name (last name)
Given Name (first name)

Action

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

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 (Rev. 08/22/11) N

Part 2. Information About You (Continued)

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A

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8. Mailing Address
C/O (in care of name)
Street Number and Name

Apartment Number

City
Province (foreign address only)

9. Daytime Phone Number

(

)

Mobile Phone Number (if any)

(

ZIP Code

State
Country (foreign address only)

Postal Code (foreign address only)

Work Phone Number (if any)

Evening Phone Number

(

(

)

)

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?

Countries You Traveled To

Total Days
Outside the
United
States

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.

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 (Rev. 08/22/11) N Page 2

Part 3. Information About Family Members Who Reside With You

-

A

Yes

1. Do you have permanent resident family members who reside with you inside the United States?

No

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.
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)

Given Name (first name)

Middle Name (if applicable)

Relationship to You

A-Number

Given Name (first name)

Middle Name (if applicable)

Relationship to You

A-Number

Given Name (first name)

Middle Name (if applicable)

Relationship to You

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 Signature

Date (mm/dd/yyyy)
Preparer's Daytime Phone Number

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

ZIP Code

State
Country (foreign address only)

Postal Code (foreign address only)
Preparer's Fax Number

(

)
Form N-470 (Rev. 08/22/11) N Page 3