Page 1, Part 1. Information About You
|
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 (three 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)
[new]
2. U.S. Social Security Number
(if any)
3. Date of Birth
(mm/dd/yyyy)
[moved up]
4. Country of Birth
5. Date You Became a Permanent
Resident (mm/dd/yyyy)
6. Country of Nationality
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
8. Mailing Address
C/O (in care of name)
Street Number and Name
Apartment Number
City
State
ZIP Code
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
City
State
ZIP Code
Country
9. Daytime Phone Number
Work Phone Number (if any)
Evening Phone Number
Mobile Phone Number (if
any)
10. E-mail Address (if
any)
|
[Page 1]
Part 1.
Information About You
[Delete]
[Delete]
[No change]
1. Your
Current Legal Name (do
not provide a nickname)
Family Name (Last Name)
Given Name (First Name)
Middle Name
2.
Other Names Used (if any)
List all other
names you have ever used, including aliases, maiden name, and
nicknames. If you need extra space to complete this section, use
the space provided in Part 5.
Additional Information.
Family Name
(Last Name) [2 boxes]
Given Name
(First Name) [2 boxes]
Middle Name [2
boxes]
3. U.S.
Social Security Number (if any)
4. USCIS
Online Account Number (if any)
5. Date
of Birth (mm/dd/yyyy)
6. Date
You Became a Lawful Permanent Resident (mm/dd/yyyy)
7. Country
of Birth
[moved up]
8. Country
of Citizenship or Nationality
9.
Since you were admitted to the United States as a lawful
permanent resident, have you been absent for a period of
six months or longer?
Yes/No
If you
answered “Yes” to Item
Number 9., provide the
departure/arrival dates of all absences in
the space provided in Part 5.
Additional Information.
[Page2]
10.
Mailing Address
In Care Of
Name (if any)
[No change]
Apt. Ste.
Flr. Number
City or Town
[No change]
[No change]
11.
Physical Address
Street Number and Name (do
not provide a PO Box in this space unless it is your ONLY
address)
Apt. Ste.
Flr. Number
City or Town
[No change]
[No change]
[Delete]
[Delete]
|
Page 2, Part 2. Your Signature
|
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 in Part 4.
[new]
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)
|
[Page 2]
Part 2. Applicant’s
Statement, Contact
Information, Certification, and Signature
NOTE:
Read the Penalties
section of the Form N-300 Instructions before completing
this part. You must file
Form N-300 while in the United States.
Applicant’s
Statement
NOTE:
Select the box for either Item A.
or B.
in Item Number 1.
If applicable, select the box for Item
Number 2.
1.
Applicant’s Statement Regarding the Interpreter
A.
I can read and understand English, and I have read and understand
every question and instruction on this application
and my answer to every question.
B.
The interpreter named in Part
3. read to me every question and
instruction on this application
and my answer to every question in [Fillable Field], a language in
which I am fluent and I understood everything.
2.
Applicant’s Statement Regarding the Preparer
At my request,
the preparer named in Part 4.,
[Fillable Filed], prepared this application
for me based only upon information I provided or authorized.
Applicant’s
Contact Information
3.
Applicant’s Daytime
Telephone Number
4.
Applicant’s Mobile Telephone
Number (if any)
5.
Applicant’s Email Address (if
any)
[page 3]
Applicant’s
Certification
Copies of any
documents I have submitted are exact photocopies of unaltered,
original documents, and I understand that USCIS may require that I
submit original documents to USCIS at a later date. Furthermore,
I authorize the release of any
information from any of my records
that USCIS may need to
determine my eligibility for the
immigration benefit I
seek.
I further
authorize release of information contained in this application,
in supporting documents, and in my USCIS records to other entities
and persons where necessary for the administration and enforcement
of U.S. immigration laws.
I
understand that USCIS may require me to appear for an appointment
to take my biometrics (fingerprints, photograph, and/or signature)
and, at that time, if
I am required to provide biometrics, I will be required to sign an
oath reaffirming
that:
1)
I reviewed and provided or authorized all of the information in my
application;
2)
I understood all of the information contained in, and submitted
with, my application; and
3)
All of this information was complete, true, and correct at the
time of filing.
I
certify, under penalty of perjury,
that I provided or authorized all of the information in my
application,
I understand all of the information contained in, and submitted
with, my application, and that all of this information is
complete, true, and
correct.
Applicant’s
Signature
6.
Applicant’s
Signature
Date of
Signature (mm/dd/yyyy)
NOTE TO ALL
APPLICANTS: If you do not
completely fill out this application or fail to submit required
documents listed in the Instructions, USCIS may deny your
application.
|
|
[new]
|
[Page 3]
Part 3.
Interpreter’s Contact Information,
Certification, and Signature
Provide the
following information about the interpreter.
Interpreter’s
Full Name
1.
Interpreter’s Family Name (Last Name)
Interpreter’s
Given Name (First Name)
2.
Interpreter’s Business or
Organization Name (if any)
Interpreter’s
Mailing Address
3.
Street
Number and Name
Apt. Ste.
Flr.
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
[page 4]
Interpreter’s
Contact Information
4.
Interpreter’s Daytime Telephone Number
5.
Interpreter’s Mobile Telephone Number (if any)
6.
Interpreter’s Email Address (if any)
Interpreter’s
Certification
I
certify, under penalty of perjury, that:
I
am fluent in English and [Fillable
Field],
which
is the same language provided in Part
2.,
Item
B. in
Item
Number
1.,
and I have read to this applicant in the identified language every
question and instruction on this application
and his or her answer to every question. The applicant informed
me that he or she understands every instruction, question, and
answer on the application,
including the Applicant’s
Certification,
and has verified
the accuracy of every answer.
Interpreter’s
Signature
7.
Interpreter’s
Signature
Date of
Signature (mm/dd/yyyy)
|
Page 2, Part 3. Signature of Person Who Prepared This Form for
You (if applicable)
|
Part 3. Signature of Person Who
Prepared This Form for You (if applicable)
Preparer’s Firm or
Organization Name (if applicable)
Preparer’s Address
Street Number and Name
City
Country
State
ZIP Code
Preparer’s Daytime Phone
Number
Preparer’s Fax Number
Preparer’s E-mail Address (if
any)
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)
|
[Page
4]
Part
4.
Contact Information, Declaration,
and Signature
of
the Person Preparing this Application, if Other Than the Applicant
Provide
the following information about the preparer.
Preparer’s
Full Name
1.
Preparer’s Family Name (Last Name)
Preparer’s
Given Name (First Name)
2.
Preparer’s Business or Organization Name (if any)
Preparer’s
Mailing Address
3.
Street Number and Name
Apt.
Ste. Flr.
City
or Town
State
ZIP
Code
Province
Postal
Code
Country
[page
5]
Preparer’s
Contact Information
4.
Preparer’s
Daytime Telephone Number
5.
Preparer’s
Mobile
Telephone Number
6.
Preparer’s
Email
Address
(if any)
Preparer’s
Statement
7.A.
I
am not an attorney or accredited representative but have prepared
this application on behalf of the applicant
and
with the applicant’s
consent.
B.
I
am an attorney or accredited representative and my representation
of the applicant
in
this case
extends/does not extend
beyond
the preparation of this application.
NOTE:
If
you are an attorney or accredited representative whose
representation extends beyond preparation of this application, you
may be obliged to
submit a completed Form G-28, Notice of Entry of Appearance as
Attorney or Accredited Representative, with this application.
Preparer’s
Certification
By
my signature, I certify, under penalty
of perjury,
that I
prepared this application
at
the request of the applicant.
The applicant then reviewed this completed application
and
informed me that he or she understands all of the information
contained in, and submitted with, his or her application,
including the Applicant’s
Certification,
and that all of this information is complete, true, and correct.
I completed this application
based
only on information that the applicant provided to me or
authorized me to obtain or use.
Preparer’s
Signature
[Deleted]
8.
Preparer’s Signature
Date of
Signature (mm/dd/yyyy)
|
Page 3, Part 4. Declaration of Intent
|
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)
2. U.S. Social Security Number
(if any)
3. Date of Birth
(mm/dd/yyyy)
5. Date You Became a Permanent
Resident (mm/dd/yyyy)
4. Country of Birth
6. Country of Nationality
7. Home Address
Street Number and Name (do not
provide a P.O. Box in this space)
Apartment Number
City
Country
State
ZIP Code
8. Mailing Address
C/O (in care of name)
Street Number and Name
City
State
ZIP Code
[moved down]
9. Daytime Phone Number
Work Phone Number (if any)
Evening Phone 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 photograph 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)
Date (mm/dd/yyyy)
USCIS Officer’s Signature
Date (mm/dd/yyyy)
|
[Page 7]
Part 6.
Declaration of Intent
1. Your
Current Legal Name (do
not provide a nickname)
Family Name (Last
Name)
Given Name (First
Name)
Middle Name
2. U.S.
Social Security Number (if any)
3.
USCIS Online Account Number (if any)
4. Date
of Birth (mm/dd/yyyy)
5. Date
You Became a Lawful Permanent Resident
(mm/dd/yyyy)
6. Country
of Birth
7. Country
of Citizenship or Nationality
[moved down]
8. Mailing
Address
In Care Of
Name (if any)
Street Number and Name
Apt. Ste.
Flr. Number
City
State
ZIP Code
9.
Physical Address
Street Number and Name (Do
not provide a PO Box in this space)
Apt. Ste.
Flr. Number
City or Town
[Delete]
State
ZIP Code
10.
Daytime Telephone Number
11.
Work Telephone Number (if any)
12.
Evening Telephone Number
13.
Mobile Telephone Number (if any)
14. Email
Address (if any)
[Page
8]
I am over 18
years of age, have been lawfully
admitted to the United States as a lawful
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 photograph 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.
15.
Applicant’s Signature (USCIS will reject your Form N-300 if
it is not signed)
Date of
Signature (mm/dd/yyyy)
16.
USCIS Officer’s Signature
Date of
Signature (mm/dd/yyyy)
[Affix Photo Here]
|