COMPLETE, SIGN, and DATE this passport amendment/validation application.
SEND it with your U.S. passport and any required additional evidence to:
THERE IS NO FEE TO HAVE A U.S. PASSPORT AMENDED. Your amended U.S. passport and any documentary evidence submitted will be
returned to you by first-class mail.
For faster processing, you may request Expedited Service. Expedite requests will be processed in three workdays from receipt at the
Passport Center. The fee for expedited service is $60. Enclose the $60 expedite fee in the form of a personal check or money order. All
fees should be payable to the "U.S. DEPARTMENT OF STATE." Do not send cash. Expedited Service is available only in the United
States.
If you desire SPECIAL POSTAL SERVICE (overnight mail, special delivery, etc.), include appropriate postage fees or a pre-paid envelope.
NOTE: The Passport Center will NOT mail a passport to a private address outside the United States.
Charleston Passport Center
Attn: Amendments
1269 Holland Street
Charleston, SC 29405
HOW TO APPLY FOR AMENDMENT/VALIDATION OF YOUR U.S. PASSPORT
U.S. PASSPORT AMENDMENT/VALIDATION APPLICATION
U.S. Department of State
DS-19
Page 2 of 2
YOU MAY REQUEST AMENDMENT/VALIDATION OF YOUR PASSPORT FOR THE FOLLOWING REASONS ONLY:
TO SHOW A CHANGE OF NAME. Submit documentary evidence such as a certified court order, marriage certificate, or other
satisfactory evidence to support a change of name.
TO CORRECT THE DESCRIPTIVE DATA. Submit appropriate evidence to support correction of descriptive data.
TO ADD VISA SUPPLEMENT PAGES.
TO EXTEND THE VALIDITY OF A LIMITED U.S. PASSPORT. Submit appropriate evidence to support your request.
IN CERTAIN CASES, TO SHOW ENDORSEMENT OR VALIDATION OF YOUR U.S. PASSPORT. Submit appropriate evidence.
ATTENTION: IF THERE IS AN ERROR IN THE DESCRIPTIVE DATA OF YOUR RECENTLY ISSUED PASSPORT, PLEASE FORWARD YOUR
REQUEST TO THE RESPECTIVE ISSUING AGENCY
AUTHORITIES: The information solicited on this form is requested pursuant to provisions in Titles 8, 18, and 22 of the United States Code, whether or
not codified, including specifically 22 U.S.C. 211a, 212, and 213, and all regulations issued pursuant to Executive Order 11295 (August 5, 1966),
including Part 51, Title 22, Code of Federal Regulations (CFR). Also, as specifically noted, pursuant to 26 U.S.C. 6039E.
PURPOSE: The primary purpose for soliciting the information is to establish citizenship, identity, and entitlement to issuance of a U.S. passport. The
information may also be used in connection with issuing other travel documents or evidence of citizenship, and in furtherance of the Secretary's
responsibility for the protection of U.S. nationals abroad.
ROUTINE USES: The information solicited on this form may be made available as a routine use to other government agencies, to assist the U.S.
Department of State in adjudicating passport applications, and for law enforcement and administrative purposes. It may also be disclosed pursuant to
court order. The information may be made available to foreign government agencies to fulfill passport control and immigration duties or to investigate or
prosecute violations of law. The information may be made available to private U.S. citizen 'wardens' designated by U.S. embassies and consulates.
Failure to provide the information requested on this form may also result in the denial of a United States passport, related document, or service to the
individual seeking such passport, document, or service.
Public reporting burden for this collection of information is estimated to average 5 minutes per response, including time required for searching existing
data sources, gathering the necessary data, providing the information required, and reviewing the final collection. You do not have to provide the
information unless this collection displays a currently valid OMB number. Send comments on the accuracy of this estimate of the burden and
recommendations for reducing it to: U.S. Department of State (A/RPS/DIR) Washington, DC 20520.
PRIVACY ACT AND PAPERWORK REDUCTION ACT STATEMENTS
ACTS OR CONDITIONS
26 U.S.C. 6039E (Internal Revenue Code) requires a passport applicant to provide his or her name and social security number. If you have not been
issued a social security number, enter zeros in the designated box. The U.S. Department of State must provide this information to the Internal Revenue
Service routinely. Any applicant who fails to provide the required information is subject to a $500 penalty enforced by the IRS. All questions on this
matter should be referred to the nearest IRS office.
FEDERAL TAX LAW
Submit your U.S. Government or military authorization in addition to the items listed above. Consult your sponsoring Agency for
instructions on proper routing procedures before forwarding this application. Your amended/validated passport will be released to your
sponsoring Agency for forwarding to you.
NOTICE TO APPLICANTS FOR AMENDMENT/VALIDATION OF OFFICIAL, DIPLOMATIC, OR NO-FEE PASSPORTS
•
•
•
•
•
•
•
•
•
•
(If any of the below-mentioned acts or conditions has been performed by or apply to the applicant, the portion which applies should be lined out, and a
supplementary explanatory statement under oath (or affirmation) by the applicant should be attached and made a part of this application.) I have not,
since acquiring United States citizenship, been naturalized as a citizen of a foreign state; taken an oath or made an affirmation or other formal
declaration of allegiance to a foreign state; entered or served in the armed forces of a foreign state; accepted or performed the duties of any office,
post, or employment under the government of a foreign state or political subdivision thereof; made a formal renunciation of nationality either in the
United States, or before a diplomatic or consular officer of the United States in a foreign state; or been convicted by a court or court martial of
competent jurisdiction of committing any act of treason against, or attempting by force to overthrow, or bearing arms against, the United States, or
conspiring to overthrow, put down, or to destroy by force, the Government of the United States.
WARNING: False statements made knowingly and willfully in passport applications or in affidavits or other supporting documents submitted therewith
are punishable by fine and/or imprisonment under provisions of 18 U.S.C. 1001 and/or 18 U.S.C. 1542. Alteration or mutilation of a passport issued
pursuant to this application is punishable by fine and/or imprisonment under the provisions of 18 U.S.C. 1543. The use of a passport in violation of the
restrictions contained therein or of the passport regulations is punishable by fine and/or imprisonment under 18 U.S.C. 1544. All statements and
documents submitted are subject to verification.
