1.Name (First, Middle, Last)

NATURALIZATION

1.Name (first, middle, last)

1a.Other names used

2. SS#

3. A#

4. Address

4a. Phone #

5. Date of Birth

6. Place of Birth

7. Citizenship

8. How would you like to change your name? (if applicable)

9. Date you became a permanent resident

10. Current marital status

11. Current address

12. Day phone number

13. Evening phone number

14. Height

15. Weight

16. Race

17. Hair color

18. Eye color

19. Addresses during the last five years (from:... to:.... dates)

Street Address, City, State/Country, ZIP code / From: mm/dd/yyyy / To: mm/dd/yyyy

20. Names and addresses of employers for the last five years (from:... to:... mm/dd/yyy). Include the occupation

Name of company / Address / Occupation / From: / To:

21. All trips of 24 hours and more that you have outside of the US since becoming a Lawful permanent resident

Date you left the US
Mm/dd/ year / Date you returned to the US mm/dd/year / Countries to which you traveled / Total days out of the US

22. How many times have you been married?

23.Current Spouse’s name (first, middle, last)

23a. Date of birth

23b. Date of present marriage

23c. SS# of the spouse

23d. Home address of the spouse

23e. Is your spouse a US citizen? Y/N

23f. If not – spouse‘s country of citizenship and A# (if applicable)

23g. Spouse‘s immigration status

24. Former (prior) spouse’s information

24a. Former (prior) Spouse’s name (first, middle, last)

24b. Former (prior) Spouse‘s immigration status

24c. Date of marriage

24d. Date marriage ended

24e. How marriage ended: divorce/spouse died/other

25. How many times your current spouse has been married?

26. Information about your current spouse’s prior marriage

26a. Prior Spouse’s name (first, middle, last)

26b. Prior Spouse‘s immigration status

26c. Date of marriage

26d. Date of marriage ended

26e. How marriage ended: divorce/spouse died/other

27. Information about your children

Full name / Date of birth
Mm/dd/year / Alien # / Country of birth / Current address

28. Have you ever, in or outside of the US, been arrested, cited, charged, indicated, fined or imprisoned for braking or violating any law or ordinance?

29. Do you owe any taxes to the Government?

30. Have you ever been in removal proceedings?