Form N-470 Application to Preserve Residence for Naturalization

Application to Preserve Residence
for Naturalization Purposes

USCIS
Form N-470

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

OMB No. 1615-0056
Expires 09/30/2022

For USCIS Use Only
Barcode

Action Block

Date Stamp

Remarks

To be completed by an
attorney or accredited
representative (if any).

Select this box if
Form G-28 is
attached.

Attorney State Bar Number
(if applicable)

Attorney or Accredited Representative
USCIS Online Account Number (if any)

► START HERE - Type or print in black ink.
NOTE: Type or print "N/A" if an item is not applicable. Type or print "None" if the answer is none. Failure to answer all of the
questions may delay your Form N-470.
Enter Your 9 Digit A-Number:
► APart 1. Information About Your Eligibility
My absence from the United States is on behalf of (Select only one box):
1.

The U.S. Government (employed by, or are under contract with, the U.S. Government).

2.

An American institution of research to perform scientific research.

3.

An American firm or corporation, or a subsidiary thereof, to engage in the development of foreign trade and commerce of the
United States.

4.

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.

5.

A public international organization of which the United States is a member. (Your employment must have started after your
admission as a lawful permanent resident.)

6.

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.

Your Current Legal Name (do not provide a nickname)
Family Name (Last Name)

2.

Given Name (First Name)

Middle Name

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 7. Additional Information.
Family Name (Last Name)

Form N-470 12/02/19

Given Name (First Name)

Middle Name

Page 1 of 7

► A-

Part 2. Information About You (continued)
3.

Your name exactly as it appears on your Permanent Resident Card
Family Name (Last Name)

4.

USCIS Online Account Number (if any)

Given Name (First Name)

5.

Middle Name

U.S. Social Security Number (if any)

6.

Date of Birth (mm/dd/yyyy)

►

►
7.

Country of Birth

8.

Country of Citizenship or Nationality

9.

Physical Address (do not provide a PO Box in this space unless it is your only address)

(USPS

ZIP Code Lookup)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

ZIP Code

Country

10. Mailing Address (if different from the address above)

(USPS ZIP Code Lookup)

In Care Of Name (if any)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

ZIP Code

Country

11. Date You Became a Lawful 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
one year since your admission as a lawful permanent resident? (If you answer “No,” provide an
explanation in the space provided in Part 7. Additional Information.)

Yes

No

13. Time Outside the United States (include trips to Canada, Mexico, and the Caribbean)
Provide all the trips of 24 hours or more that you have taken outside the United States since you became a lawful permanent
resident. Begin with your most recent trip. If you need extra space to complete this section, use the space provided in Part 7.
Additional Information.
Date You Left the Date You Returned Did Trip Last
United States
to the United States Six Months or
(mm/dd/yyyy)
(mm/dd/yyyy)
More?
Yes
No

Form N-470 12/02/19

Yes

No

Yes

No

Yes

No

Countries You Traveled To

Total Days
Outside the
United States

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► A-

Part 2. Information About You (continued)

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 lawful
permanent resident?

Yes

No

Part 3. Information About Family Members Who Reside With You
1.

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

Yes

No

2.

If you answered "Yes" to Item Number 1., will those family members reside with you outside the United
States?

Yes

No

If you answered “Yes,” provide the information below for each lawful permanent resident family member who will be residing
with you outside the United States. If you need extra space to complete this section, use the space provided in Part 7. Additional
Information.
A. Family Name (Last Name)

Date of Birth (mm/dd/yyyy)

Given Name (First Name)

Relationship to You

Middle Name (if applicable)

A-Number
► A-

B. Family Name (Last Name)

Date of Birth (mm/dd/yyyy)

Given Name (First Name)

Relationship to You

Middle Name (if applicable)

A-Number
► A-

C. Family Name (Last Name)

Date of Birth (mm/dd/yyyy)

Given Name (First Name)

Relationship to You

Middle Name (if applicable)

A-Number
► A-

Part 4. Applicant's Statement, Contact Information, Certification, and Signature
NOTE: Read the Penalties section of the Form N-470 Instructions before completing this part.

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.

2.

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 5. has read to me every question and instruction on this application and my answer to
every question, in
, a language in which I am fluent and I understood
everything.

Applicant's Statement Regarding the Preparer
At my request, the preparer named in Part 6.
prepared this application for me based only upon information I provided or authorized.

Form N-470 12/02/19

,
Page 3 of 7

Part 4. Applicant's Statement, Contact Information, Certification, and
Signature (continued)

► A-

Applicant's Contact Information
3.

Applicant's Daytime Telephone Number

5.

Applicant's Email Address (if any)

4.

Applicant's Mobile Telephone Number (if any)

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 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.

Part 5. 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. Number

City or Town

State

Province

Form N-470 12/02/19

Postal Code

ZIP Code

Country

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Part 5. Interpreter's Contact Information, Certification, and Signature ► A(continued)
Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

6.

Interpreter's Email Address (if any)

5.

Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
, which is the same language specified in Part 4.,
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)

Part 6. 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. Number

City or Town

State

Province

Form N-470 12/02/19

Postal Code

ZIP Code

Country

Page 5 of 7

Part 6. Contact Information, Declaration, and Signature of the Person
Preparing this Application, if Other Than the Applicant (continued)

► A-

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

6.

Preparer's Email Address (if any)

5.

Preparer's Mobile Telephone Number (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 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
8.

Preparer's Signature

Form N-470 12/02/19

Date of Signature (mm/dd/yyyy)

Page 6 of 7

Part 7. Additional Information
If you need extra space to provide any additional information within this application, use the space below. If you need more space
than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper.
Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item
Number to which your answer refers; and sign and date each sheet.
1.

Family Name (Last Name)

Given Name (First Name)

2.

A-Number (if any) ► A-

3.

A. Page Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

Middle Name

D.

4.

A. Page Number

D.

5.

A. Page Number

D.

6.

A. Page Number

D.

Form N-470 12/02/19

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