Form N470 Uscis
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4OMB No. 1615-0056; Expires 01/31/2016
Form N-470, Application to Preserve
Department of Homeland Security
Residence for Naturalization Purposes
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)
-
-
A
My absence from the United States is on behalf of:
1.
The U.S. Government (employed by, or are under contract with, the U.S.
For USCIS Use Only
Government).
Bar Code
Date Stamp
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.
Remarks
(Your employment must have started after your admission as a 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. 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)
U.S. Social Security
4. Date of Birth
3.
5.
Country of
6.
Country of
Number (if any)
(mm/dd/yyyy)
Birth
Nationality
7. Home Address
Street Number and Name (do not write a P.O. Box in this space unless it is your ONLY address.)
Apartment Number
City
County
ZIP Code
State
Province (foreign address only)
Postal Code (foreign address only)
Country (foreign address only)
Form N-470 01/03/13 N Page 1
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