N-300, Application to File Declaration of Intention - ILW.com

Department of Homeland Security
U.S. Citizenship and Immigration Services
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
Given Name
Middle Name
OMB No. 1615-0078; Expires 07/31/09
N-300, Application to File
Declaration of Intention
Returned
Resubmitted
For USCIS Use Only
Receipt
Street Number and Name
Apt. #
City
State or Province
Reloc Sent
Country
Zip/Postal Code
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship
Reloc Rec'd
U.S. Social Security # (If any)
A# (If any)
Telephone Number
( )
Part 2. Processing Information.
Date you became a permanent resident (mm/dd/yyyy)
E-Mail Address (If any)
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 U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am
seeking.
Signature
Date
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. 07/08/08)Y

Original to be retained by USCIS - Duplicate to be given to:
Family Name
Given Name
Middle Name
Address - C/O
Street Number and Name
Apt. #
Affix
City
Country
State or Province
Zip/Postal Code
Photograph
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship
Here
U.S. Social Security # (If any)
Telephone Number
( )
A# (If any)
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 pursuant to such
admission.
Not valid unless DHS Seal
applied below.
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. 07/08/08)Y Page 2

Original to be retained by USCIS - Duplicate to be given to:
Family Name
Given Name
Middle Name
Address - C/O
Street Number and Name
Apt. #
Affix
City
Country
State or Province
Zip/Postal Code
Photograph
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship
Here
U.S. Social Security # (If any)
Telephone Number
( )
A# (If any)
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 pursuant to such
admission.
Not valid unless DHS Seal
applied below.
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. 07/08/08)Y Page 3