If You Need More Space Use An Extra Page

Write on these sheets ALL the required information BEFORE you come back to our
office to process your citizenship.
LEGAL NAME: ______________________________________ A#___________________ SSN__________________
OTHER NAMES USED:

First ____________________________ Middle: ______________________ Last: _____________________________
First ____________________________ Middle: ______________________ Last: _____________________________
**Would you like to legally change your name? If so, please provide your desired name below**
Last Name(s) _______________________________ First _____________________ Middle ________________________
ADDRESSES during the last five years (Starting with the most recent one)
From To
Number, Street name and apt # City State Zip Code Month/Year Month/Year
___________________________________________ ____ ________ __________ Present
___________________________________________ ____ ________ __________ ______________
___________________________________________ ____ ________ __________ ______________
___________________________________________ ____ ________ __________ ______________
___________________________________________ ____ ________ __________ ______________
___________________________________________ ____ ________ __________ ______________

(If you need more space use an extra page)
PARENTS Information (Only if they are US Citizens)

Were your parents married before your 18th birthday? Yes ____ No ____
Mother: Legal Name ____________________________________ Country of Birth _____________________
Date of Birth ______________ A# _________________ Date of Naturalization: __________________________
Father: Legal Name ____________________________________ Country of Birth ______________________
Date of Birth ______________ A# _________________ Date of Naturalization: ___________________________
BIOGRAPHIC INFORMATION
Height: ______ ft. ______ in. Weight: _______ Eye Color: ________ Hair Color: ________
1
EMPLOYMENT during the last five years (Starting with the most recent one)
From To
Name of Employer/School Complete Address Month/Year Month/Year Occupation
____________________ ____________________________________ __________ Present _________
____________________ ____________________________________ __________ __________ __________
____________________ ____________________________________ __________ __________ __________
____________________ ____________________________________ __________ __________ __________

TRIPS made outside of the United States during last five years
(List below ALL trips of 24 hrs. or more )
Month/Day/Year Month/Day/Year Were you gone for Total days out
Left U.S. Returned U.S six months or more? Country of USA
_______________ ______________ yes ___ no ____ ______________________ __________
_______________ ______________ yes ___ no ____ ______________________ __________
_______________ ______________ yes ___ no ____ ______________________ __________
_______________ ______________ yes ___ no ____ ______________________ __________
_______________ ______________ yes ___ no ____ ______________________ __________
_______________ ______________ yes ___ no ____ ______________________ __________
_______________ ______________ yes ___ no ____ ______________________ __________
_______________ ______________ yes ___ no ____ ______________________ __________

If you are MARRIED give information of your CURRENT spouse

How many times have YOU been married? _________ How many times has YOUR spouse been married? ________
Legal name of spouse: _________________________________________________________________________
Previous legal name of spouse: __________________________________________________________________
Home Address: _______________________________________________________________________________
Name of spouse’s employer: ____________________________________________________________________
Date of marriage: _____________________ Date of Birth: _______________________ Alien #: ______________
Country of Birth: _____________________ Country of Citizenship: _____________________________________
If your husband or wife IS a U.S. citizen: Date of Naturalization (Month/Day/Year)

If your husband or wife IS NOT a U.S. citizen: Immigration Status (None or Resident)
2
If YOU or your SPOUSE, were married more than once we will need information on ALL your
PREVIOUS MARRIAGES:
Name of your ex-spouse: Date of Birth: __________ Country of Birth: ___________
Date of marriage: Date of Divorce: ___________ Immigration Status: (None / Resident / Citizen)
Name of his/her ex-spouse: _ Date of Birth: __________Country of Birth: __________
Date of marriage: Date of Divorce: ___________ Immigration Status: (None / Resident / Citizen)
CHILDREN (Include stepchildren, legally adopted children, and deceased children)
Complete Full Date Alien Country of Complete Address

Legal Name (Birth Certificate) of Birth Number Birth in the US or Abroad
(if Applicable)
_________________________/___________/________________/____________/______________________
_________________________/___________/________________/____________/______________________
_________________________/___________/________________/____________/______________________
_________________________/___________/________________/____________/______________________
_________________________/___________/________________/____________/______________________
_________________________/___________/________________/____________/______________________
_________________________/___________/________________/____________/______________________
Have you ever been ARRESTED, CITED, or DETAINED by ANY* law enforcement officer for any reason,
including traffic tickets? (*Including Immigration, military officer or police officer) please write below
WHY DATE WHERE OUTCOME OR

arrested or cited arrested or cited City & State DISPOSITION
_____________________ _________________ ______________________ _________________________
_____________________ _________________ ______________________ _________________________
_____________________ _________________ ______________________ _________________________
___________________ ________________ ____________________ _______________________
_____________________ _________________ ______________________ _________________________


If You Need More Space Use An Extra Page

Uploaded by

Copyright:

Available Formats

If You Need More Space Use An Extra Page

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

If You Need More Space Use An Extra Page

Uploaded by

Copyright:

Available Formats

Write on these sheets ALL the required information BEFORE you come back to our

office to process your citizenship.

LEGAL NAME: ______________________________________ A#___________________ SSN__________________

OTHER NAMES USED:

First ____________________________ Middle: ______________________ Last: _____________________________

Last Name(s) _______________________________ First _____________________ Middle ________________________

___________________________________________ ____ ________ __________ Present

___________________________________________ ____ ________ __________ ______________

___________________________________________ ____ ________ __________ ______________

___________________________________________ ____ ________ __________ ______________

___________________________________________ ____ ________ __________ ______________

___________________________________________ ____ ________ __________ ______________

PARENTS Information (Only if they are US Citizens)

Mother: Legal Name ____________________________________ Country of Birth _____________________

Date of Birth ______________ A# _________________ Date of Naturalization: __________________________

Father: Legal Name ____________________________________ Country of Birth ______________________

Date of Birth ______________ A# _________________ Date of Naturalization: ___________________________

____________________ ____________________________________ __________ Present _________

____________________ ____________________________________ __________ __________ __________

____________________ ____________________________________ __________ __________ __________

____________________ ____________________________________ __________ __________ __________

_______________ ______________ yes ___ no ____ ______________________ __________

_______________ ______________ yes ___ no ____ ______________________ __________

_______________ ______________ yes ___ no ____ ______________________ __________

_______________ ______________ yes ___ no ____ ______________________ __________

_______________ ______________ yes ___ no ____ ______________________ __________

_______________ ______________ yes ___ no ____ ______________________ __________

_______________ ______________ yes ___ no ____ ______________________ __________

_______________ ______________ yes ___ no ____ ______________________ __________

If you are MARRIED give information of your CURRENT spouse

Legal name of spouse: _________________________________________________________________________

Previous legal name of spouse: __________________________________________________________________

Home Address: _______________________________________________________________________________

Name of spouse’s employer: ____________________________________________________________________

Date of marriage: _____________________ Date of Birth: _______________________ Alien #: ______________

Country of Birth: _____________________ Country of Citizenship: _____________________________________

If your husband or wife IS a U.S. citizen: Date of Naturalization (Month/Day/Year)

Name of his/her ex-spouse: _ Date of Birth: __________Country of Birth: __________

CHILDREN (Include stepchildren, legally adopted children, and deceased children)

Complete Full Date Alien Country of Complete Address

WHY DATE WHERE OUTCOME OR

_____________________ _________________ ______________________ _________________________

_____________________ _________________ ______________________ _________________________

_____________________ _________________ ______________________ _________________________

___________________ ________________ ____________________ _______________________

_____________________ _________________ ______________________ _________________________

You might also like

LEGAL NAME: ____________________________ A#_ SSN__________

First Middle: Last: ___

Last Name(s) _____________________ First _ Middle ______________

_________________________________ Present

___________________________

___________________________

___________________________

___________________________

___________________________

Mother: Legal Name ________________ Country of Birth _

Date of Birth ______ A# _ Date of Naturalization: __________________

Father: Legal Name ______________ Country of Birth

Date of Birth ______ A# _ Date of Naturalization: ___________________

______ Present _

______

______

______

___ yes _ no ________

___ yes _ no ________

___ yes _ no ________

___ yes _ no ________

___ yes _ no ________

___ yes _ no ________

___ yes _ no ________

___ yes _ no ________

Date of marriage: _________ Date of Birth: _ Alien #: ____

Country of Birth: _ Country of Citizenship: _________________

Name of his/her ex-spouse: _ Date of Birth: Country of Birth:

_____________ _ ___________

_____________ _ ___________

_____________ _ ___________

_ _____

_____________ _ ___________