Replacement Passport Application Form - Urgent Passport Services Page 2
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4REPLACEMENT PASSPORT INSTRUCTIONS
PLEASE READ THESE INSTRUCTIONS CLOSELY.
THIS CHECKLIST SHOWS ALL REQUIRED DOCUMENTS.
1-800-573-3738
REPLACEMENT PASSPORT CHECKLIST:
United States Passport In Need of Replacing
- Replacement passports are for adults whose passports were issued within the last 12 months and have had a
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name change during that same time period. If it has been more than a year since your passport was issued you
must apply for a Passport Renewal. Replacement Passports are used for name changes or correct any descriptive
data errors.
Digitally Typed and Printed State Department DS-5504 Passport Application (PART 2 on our site)
- This online application can also be found here -
https://pptform.state.gov/
(handwritten form NOT acceptable)
- Go Past the privacy disclaimer – and on the next page click SUBMIT under “Apply Online”
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- Enter all passport information requested by the State Department – red asterisk fields required
- “Summary of Fees” page (only check $60 Expedite at Agency Fee & $0 Passport Book Fee) click SUBMIT
- “Next Steps” Page – Scroll to the bottom of the page and click CREATE FORM
- Your completed Passport Application form will open as a PDF document, PRINT IT OUT
Two Recent Passport Photos
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- Go to your local Kinko's, CVS, or Photo Shop (Do not staple your photos to the form) (no glasses or head wear)
Proof of Travel Departure (Include one of the following)
- One clear photocopy of an Airline Plane Ticket Confirmation with your name as the passenger
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- If driving across the border include a copy of a foreign hotel reservation with your name as the guest
- If traveling for business you may type a company letter (see sample)
Photocopy of Identification (Include one of the following)
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- One clear photocopy of your valid state issued Driver's License, State ID Card, or Military ID
Government Fee of $60.00
- Passport Fee must be paid with a Personal Check or Money Order payable to “US Department of State”
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- Write your date of birth in the memo portion of your check or money order
- Check or money order must be clear - Name & Address must be on check - Scratch outs or post dates get rejected
Urgent Passport Letter of Authorization
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- This form is included in this PDF document - please complete by hand with blue or black ink
- We recommend only checking the first 2 boxes for best service / Courier Company Name is "Urgent Passport"
Letter of Explanation for Replacement & Certified Marriage Certificate or Divorce Decree
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- Please be detailed in your letter explaining how and when your name changed - sign and date the letter
Urgent Passport Order Form & Expediting Fee
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- The order form is included in this PDF document - can be completed by hand or typed in
- Please fill this form out completely - including expediting service, payment info, and shipping info
SHIPPING INFORMATION: WHEN READY TO SHIP CALL 1-800-573-3738
SHIPPING ADDRESS #1
SHIPPING ADDRESS #2
(FEDEX ONLY)
(FEDEX ONLY)
URGENT PASSPORT
URGENT PASSPORT
230 S. CLARK ST.
4901 S. ZUNI ST.
# 222
(FEDEX HOLD - J. PALSON)
CHICAGO, IL 60604
LITTLETON, CO 80120
* WE WILL ROUTE YOU TO THE SHIPPING ADDRESS THAT PROVIDES THE FASTEST SERVICE *
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