N-300, Application to File Declaration of Intention - ILW.com
N-300, Application to File Declaration of Intention - ILW.com
N-300, Application to File Declaration of Intention - ILW.com
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Department <strong>of</strong> Homeland Security<br />
U.S. Citizenship and Immigration Services<br />
START HERE - Please type or print in black ink.<br />
Part 1. Information about you. (NOTE: Applicant must <strong>com</strong>plete<br />
all three pages <strong>of</strong> this form.)<br />
Family Name<br />
Address - C/O<br />
Given Name<br />
Middle Name<br />
OMB No. 1615-0078; Expires 07/31/09<br />
N-<strong>300</strong>, <strong>Application</strong> <strong>to</strong> <strong>File</strong><br />
<strong>Declaration</strong> <strong>of</strong> <strong>Intention</strong><br />
Returned<br />
Resubmitted<br />
For USCIS Use Only<br />
Receipt<br />
Street Number and Name<br />
Apt. #<br />
City<br />
State or Province<br />
Reloc Sent<br />
Country<br />
Zip/Postal Code<br />
Date <strong>of</strong> Birth (mm/dd/yyyy)<br />
Country <strong>of</strong> Birth<br />
Country <strong>of</strong> Citizenship<br />
Reloc Rec'd<br />
U.S. Social Security # (If any)<br />
A# (If any)<br />
Telephone Number<br />
( )<br />
Part 2. Processing Information.<br />
Date you became a permanent resident (mm/dd/yyyy)<br />
E-Mail Address (If any)<br />
Since you were admitted <strong>to</strong> the United States as a permanent resident, have you been absent for a<br />
period <strong>of</strong> six months or longer? No Yes Attach a list <strong>of</strong> departure/arrival dates <strong>of</strong> all<br />
absences.<br />
Read the information on penalties in the instructions before<br />
Part 3. Signature.<br />
<strong>com</strong>pleting this section. You must be in the United States when you<br />
file this application. You must sign your name below and also sign<br />
your name in the appropriate places (Signature <strong>of</strong> Applicant on Pages<br />
2 and 3) <strong>of</strong> this form.<br />
I desire <strong>to</strong> declare my intention <strong>to</strong> be<strong>com</strong>e a citizen <strong>of</strong> the United States. I certify, under penalty<br />
<strong>of</strong> perjury under the laws <strong>of</strong> the United States <strong>of</strong> America, that this application and the evidence<br />
submitted with it is all true and correct. I authorize release <strong>of</strong> any information from my records<br />
that U.S. Citizenship and Immigration Services needs <strong>to</strong> determine eligibility for the benefit I am<br />
seeking.<br />
Signature<br />
Date<br />
Applicant<br />
Interviewed<br />
Action Block<br />
Part 4. Signature <strong>of</strong> person preparing form, if other than above.<br />
(Sign below.)<br />
I declare that I prepared this application at the request <strong>of</strong> the above person, and it is based on all<br />
information <strong>of</strong> which I have any knowledge.<br />
Signature<br />
Date<br />
Print Your Name<br />
Firm Name<br />
Firm Address<br />
To Be Completed by<br />
At<strong>to</strong>rney or Representative, if any<br />
Fill in box if G-28 is attached <strong>to</strong><br />
represent the applicant.<br />
ATTY State License #<br />
Telephone Number<br />
( )<br />
E-Mail Address (If any)<br />
Form N-<strong>300</strong> (Rev. 07/08/08)Y
Original <strong>to</strong> be retained by USCIS - Duplicate <strong>to</strong> be given <strong>to</strong>:<br />
Family Name<br />
Given Name<br />
Middle Name<br />
Address - C/O<br />
Street Number and Name<br />
Apt. #<br />
Affix<br />
City<br />
Country<br />
State or Province<br />
Zip/Postal Code<br />
Pho<strong>to</strong>graph<br />
Date <strong>of</strong> Birth (mm/dd/yyyy)<br />
Country <strong>of</strong> Birth<br />
Country <strong>of</strong> Citizenship<br />
Here<br />
U.S. Social Security # (If any)<br />
Telephone Number<br />
( )<br />
A# (If any)<br />
E-Mail Address (If any)<br />
I am over the age <strong>of</strong> 18 years, have been lawfully admitted <strong>to</strong> the United States as a<br />
permanent resident, and am now residing in the United States pursuant <strong>to</strong> such<br />
admission.<br />
Not valid unless DHS Seal<br />
applied below.<br />
I hereby declare my intention in good faith <strong>to</strong> be<strong>com</strong>e a citizen <strong>of</strong> the United States and<br />
I certify that the pho<strong>to</strong>graphs affixed <strong>to</strong> the original and duplicate here<strong>of</strong> are a likeness<br />
<strong>of</strong> me and were signed by me.<br />
I do swear (or affirm) that the statements I have made and the intentions I have<br />
expressed in this declaration <strong>of</strong> intention subscribed by me are true <strong>to</strong> the best <strong>of</strong> my<br />
knowledge and belief.<br />
Signature <strong>of</strong> Applicant<br />
Signature <strong>of</strong> Authorizing Official<br />
Date<br />
Date<br />
Original Copy/Retained by USCIS Form N-<strong>300</strong> (Rev. 07/08/08)Y Page 2
Original <strong>to</strong> be retained by USCIS - Duplicate <strong>to</strong> be given <strong>to</strong>:<br />
Family Name<br />
Given Name<br />
Middle Name<br />
Address - C/O<br />
Street Number and Name<br />
Apt. #<br />
Affix<br />
City<br />
Country<br />
State or Province<br />
Zip/Postal Code<br />
Pho<strong>to</strong>graph<br />
Date <strong>of</strong> Birth (mm/dd/yyyy)<br />
Country <strong>of</strong> Birth<br />
Country <strong>of</strong> Citizenship<br />
Here<br />
U.S. Social Security # (If any)<br />
Telephone Number<br />
( )<br />
A# (If any)<br />
E-Mail Address (If any)<br />
I am over the age <strong>of</strong> 18 years, have been lawfully admitted <strong>to</strong> the United States as a<br />
permanent resident, and am now residing in the United States pursuant <strong>to</strong> such<br />
admission.<br />
Not valid unless DHS Seal<br />
applied below.<br />
I hereby declare my intention in good faith <strong>to</strong> be<strong>com</strong>e a citizen <strong>of</strong> the United States and<br />
I certify that the pho<strong>to</strong>graphs affixed <strong>to</strong> the original and duplicate here<strong>of</strong> are a likeness<br />
<strong>of</strong> me and were signed by me.<br />
I do swear (or affirm) that the statements I have made and the intentions I have<br />
expressed in this declaration <strong>of</strong> intention subscribed by me are true <strong>to</strong> the best <strong>of</strong> my<br />
knowledge and belief.<br />
Signature <strong>of</strong> Applicant<br />
Signature <strong>of</strong> Authorizing Official<br />
Date<br />
Date<br />
Duplicate Copy/Given <strong>to</strong> Applicant Form N-<strong>300</strong> (Rev. 07/08/08)Y Page 3