Form N-300 - Application To File Declaration Of Intention
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8Application to File Declaration of Intention
USCIS
Form N-300
Department of Homeland Security
OMB No. 1615-0078
U.S. Citizenship and Immigration Services
Expires 03/31/2018
For USCIS Use Only
Date Stamp
Receipt
Action Block
Remarks
Bar Code
To be completed by an
Attorney State Bar Number
Select this box if
Attorney or Accredited Representative
attorney or accredited
(if applicable)
Form G-28 is
USCIS Online Account Number (if any)
representative (if any).
attached.
►
START HERE - Type or print in black ink.
Enter Your 9 Digit A-Number:
►
Part 1. Information About You
A-
1.
Your Current Legal Name (do not provide a nickname)
Family Name (Last Name)
Given Name (First Name)
Middle Name
2.
Other Names Used (if any)
List all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this
section, use the space provided in Part 5. Additional Information.
Family Name (Last Name)
Given Name (First Name)
Middle Name
3.
U.S. Social Security Number (if any)
4.
USCIS Online Account Number (if any)
Date of Birth (mm/dd/yyyy)
5.
►
►
Date You Became a Lawful Permanent Resident
7.
6.
Country of Birth
(mm/dd/yyyy)
8.
Country of Citizenship or Nationality
9.
Since you were admitted to the United States as a lawful permanent resident, have you been absent for a
Yes
No
period of six months or longer?
If you answered "Yes" to Item Number 9., provide departure/arrival dates of all absences in the space provided in Part 5.
Additional Information.
Form N-300 12/23/16 N
Page 1 of 8
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