Form N-300 - Application To File Declaration Of Intention Page 2
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1
2
3Original 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
State or Province
Photograph
Country
Zip/Postal Code
Here
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship
U.S. Social Security # (If any)
A# (If any)
Telephone Number
E-Mail Address (If any)
I am over the age of 18 years, have been lawfully admitted to the United States as a
Not valid unless DHS Seal
permanent resident, and am now residing in the United States pursuant to such
applied below.
admission.
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
Form N-300 (10/30/11) N Page 2
by USCIS
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Parent category: Legal