Fillable N-300 Form N-300, Application to File Declaration of Intention

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N-300 Form N-300, Application to File Declaration of Intention

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The N-300 Form N-300, Application to File Declaration of Intention form is 8 pages long and contains:

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  • 28 check-boxes
  • 118 other fields

Country of origin: US
File type: PDF

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U.S. Citizenship and Immigration Services (USCIS) is an office of the U.S. Branch of Homeland Security (DHS) that oversees the nation's naturalization and migration framework. It is a successor to the Immigration and Naturalization Service (INS), which was disintegrated by the Homeland Security Act of 2002 and supplanted by three segments inside the DHS: USCIS, Immigration and Customs Enforcement (ICE), and Customs and Border Protection (CBP).

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To be completed by an
attorney or accredited
representative (if any).
Date Stamp
Remarks Bar Code
START HERE - Type or print in black ink.
Action BlockReceipt
Application to File Declaration of Intention
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form N-300
Part 1. Information About You
1. Your Current Legal Name (Do not provide a nickname.)
Family Name (Last Name)
Given Name (First Name)
Middle Name
8.
Since you were admitted to the United States as a lawful permanent resident, have you been absent for a
period of six months or longer?
2.
Country of Citizenship or Nationality
6.
(mm/dd/yyyy)
Country of Birth
Select this box if
Form G-28 is
attached.
Attorney State Bar Number
(if applicable)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
Yes No
If you answered "Yes" to Item Number 9., provide departure/arrival dates of all absences in the space provided in Part 5.
Additional Information.
4.
For USCIS Use Only
3. USCIS Online Account Number (if any)
►
U.S. Social Security Number (if any)
►
Enter Your 9 Digit A-Number:
►
A-
Date You Became a Lawful Permanent Resident 7.
►
Other Names Used (if any)
9.
Provide 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.
5.
Date of Birth (mm/dd/yyyy)
Family Name (Last Name) Given Name (First Name) Middle Name
Page 1 of 8
Form N-300 08/02/19
11. Physical Address (if different from the address above)
City or Town State ZIP Code
Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.) Apt. Flr. NumberSte.
Part 1. Information About You (continued)
Part 2. Applicant's Statement, Contact Information, Declaration, Certification, and Signature
NOTE: Read the Penalties section of the Form N-300 Instructions before completing this part. You must file Form N-300 while in
the United States.
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.
I can read and understand English, and I have read and understand every question and instruction on this application and
my answer to every question.
A.
Applicant's Statement Regarding the Interpreter
question in
The interpreter named in Part 3. read to me every question and instruction on this application and my answer to every
, a language in which I am
B.
At my request, the preparer named in Part 4., ,
prepared this application for me based only upon information I provided or authorized.
2. Applicant's Statement Regarding the Preparer
Applicant's Contact Information
3. 4.
5. Applicant's Email Address (if any)
Applicant's Daytime Telephone Number Applicant's Mobile Telephone Number (if any)
►
A-
Mailing Address (USPS ZIP Code Lookup)10.
City or Town State ZIP Code
Street Number and Name Apt. Flr. NumberSte.
In Care Of Name (if any)
Applicant's Statement
fluent and I understood everything.
Page 2 of 8
Form N-300 08/02/19
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
Instructions, USCIS may deny your application.
Applicant's Declaration and Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any
and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.
I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records, to
other entities and persons where necessary for the administration and enforcement of U.S. immigration law.
I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or
signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:
Applicant's Signature
Applicant's Signature Date of Signature (mm/dd/yyyy)6.
Part 2. Applicant's Statement, Contact Information, Declaration,
Certification, and Signature (continued)
Part 3. Interpreter's Contact Information, Certification, and Signature
Interpreter's Given Name (First Name)Interpreter's Family Name (Last Name)1.
Provide the following information about the interpreter.
Interpreter's Business or Organization Name (if any)2.
Interpreter's Full Name
►
A-
1) I reviewed and understood all of the information contained in, and submitted with, my application; and
2) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that all of the information in my application, and any document submitted with it were provided or
authorized by me, that I reviewed and understand all of the information contained in, and submitted with, my application, and that all
of this information is complete, true, and correct.
Interpreter's Mailing Address
3. Street Number and Name Apt. Flr. NumberSte.
City or Town
State ZIP Code
Postal CodeProvince Country
Page 3 of 8
Form N-300 08/02/19
Part 3. Interpreter's Contact Information, Certification, and Signature
(continued)
►
A-
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
, which is the same language provided in Part 2.,
Item B., in Item Number 1.; and I have read to this applicant in the identified language every question and instruction on this
application and his or her answer to every question. The applicant informed me that he or she understands every instruction, question,
and answer on the application, including the Applicant's Declaration and Certification, and has verified the accuracy of every
answer.
Date of Signature (mm/dd/yyyy)Interpreter's Signature
Interpreter's Signature
7.
Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if
Other Than the Applicant
Provide the following information about the preparer.
Preparer's Full Name
Preparer's Given Name (First Name)Preparer's Family Name (Last Name)1.
Preparer's Business or Organization Name (if any) 2.
Interpreter's Contact Information
4. Interpreter's Daytime Telephone Number
Interpreter's Email Address (if any)
6.
5. Interpreter's Mobile Telephone Number (if any)
Preparer's Mailing Address
3. Street Number and Name Apt. Flr. NumberSte.
City or Town State ZIP Code
Postal CodeProvince Country
Page 4 of 8
Form N-300 08/02/19
Part 4. Contact Information, Declaration, and Signature of the Person
Preparing this Application, if Other Than the Applicant (continued)
►
A-
I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with
the applicant's consent.
I am an attorney or accredited representative and my representation of the applicant in this case
does not extend beyond the preparation of this application.
7.
Preparer's Statement
A.
B.
extends
NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G-28, Notice of
Entry of Appearance as Attorney or Accredited Representative, with this application.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then
reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted
with, his or her application, including the Applicant's Declaration and Certification, and that all of this information is complete,
true, and correct. I completed this application based only on information that the applicant provided to me or authorized me to obtain
or use.
Preparer's Signature
Date of Signature (mm/dd/yyyy)
Preparer's Signature
8.
Preparer's Contact Information
Preparer's Daytime Telephone Number Preparer's Mobile Telephone Number (if any)
Preparer's Email Address (if any)
4.
6.
5.
Page 5 of 8
Form N-300 08/02/19
Part 5. Additional Information
If you need extra space to provide any additional information within this application, use the space below. If you need more space
than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper.
Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item
Number to which your answer refers; and sign and date each sheet.
3. Page Number
B. Part Number C. Item Number
D.
A.
A.
A.
A.
Page Number
5.
Page Number Part Number Item NumberC.B.
D.
6.
D.
B. C.
Item NumberPart NumberPage Number
Part Number Item Number
1. Family Name (Last Name) Given Name (First Name) Middle Name
C.B.
D.
4.
►
A-
A-Number (if any)2.
Page 6 of 8
Form N-300 08/02/19
Part 6. Declaration of Intention
A-
Your Current Legal Name (Do not provide a nickname.)1.
U.S. Social Security Number (if any)2. 3. USCIS Online Account Number (if any)
►►
Family Name (Last Name) Given Name (First Name) Middle Name
►
4.
Date of Birth (mm/dd/yyyy)
Date You Became a Lawful Permanent Resident 5.
(mm/dd/yyyy)
7.6.
8. Mailing Address
9.
Daytime Telephone Number
12. Mobile Telephone Number (if any)13.Evening Telephone Number
11. Work Telephone Number (if any)10.
Email Address (if any)14.
Original Mailed to Applicant/Copy to File
Country of Birth Country of Citizenship or Nationality
Physical Address
City or Town State ZIP Code
Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.) Apt. Flr. NumberSte.
City or Town State ZIP Code
Street Number and Name Apt. Flr. NumberSte.
In Care Of Name (if any)
Page 7 of 8Form N-300 08/02/19
Original Mailed to Applicant/Copy to File
Part 6. Declaration of Intention (continued)
A-
►
I am over 18 years of age, have been lawfully admitted to the United States as a lawful permanent resident, and am now residing in the
United States based on such 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.
Applicant's Signature (USCIS will reject your Form N-300 if it is not signed.)
USCIS Officer's Signature
Applicant's and USCIS Officer's Signature
Not valid unless DHS Seal
applied below.
Affix
Photograph
Here
Date of Signature (mm/dd/yyyy)
Date of Signature (mm/dd/yyyy)
15.
16.
Page 8 of 8
Form N-300 08/02/19
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N-300 Form N-300, Application to File Declaration of Intention

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Completed 17 November 2019

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