►
Part 2. Information About You (continued)
A-
3.
Your name exactly as it appears on your Permanent Resident Card
Family Name (Last Name)
Given Name (First Name)
Middle Name
4. USCIS Online Account Number (if any)
5.
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)
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
Province
Postal Code
Country
10.
Mailing Address (if different from the address above)
In Care Of Name (if any)
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
Province
Postal 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
Yes
No
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.)
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
Total Days
United States
to the United States
Six Months or
Countries You Traveled To
Outside the
(mm/dd/yyyy)
(mm/dd/yyyy)
More?
United States
Yes
No
Yes
No
Yes
No
Yes
No
Form N-470 12/23/16 N
Page 2 of 7