Fillable U.S. Passport Book U.S. Passport Card Protect yourself (ILW.COM)

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U.S. Passport Book U.S. Passport Card Protect yourself (ILW.COM)

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IMPORTANT NOTICE
A U.S. citizen may not normally bear more than one valid or potentially valid U.S. passport book and one valid passport
card at a time. It therefore is necessary to submit a statement with an application for a new U.S. passport when a
previously issued valid or potentially valid U.S. passport cannot be presented. Your statement must detail why the
previous U.S. passport cannot be presented. The information you provide on the DS-64, Statement Regarding a Lost
or Stolen Passport, will be placed into our Consular Lost or Stolen Passport System. This system is designed to
prevent the misuse of your lost or stolen U.S. passport. Anyone using the passport reported on the DS-64, including
yourself, may be detained upon entry into the United States. Should you locate the passport reported lost or stolen at
a later time, you should report it as found and submit it for cancellation. It has been invalidated. You may not use
that passport for travel. See page 2 of this form for additional information.
Social Security NumberPlace of Birth (State or Country)Date of Birth (mm-dd-yyyy)
Last Name
Has your name changed since the passport was issued? If yes, state the name in which the lost or stolen passport was issued.
If you have had any other U.S. passport lost or stolen, give the approximate date of this loss or theft and any additional information you can provide. If
the space provided is not sufficient to answer the question, please continue answering the question on a separate piece of paper.
Are you submitting this form in connection with an application for a new passport?
Middle NameFirst Name
STATEMENT REGARDING A LOST OR STOLEN PASSPORT
U.S. Department of State
I, the undersigned, declare under penalty of perjury that the information furnished herein is correct and complete and
that I have not given my passport book and/or passport card to another person or disposed of it in an unauthorized
manner. I understand that my passport(s) will be invalidated and cannot be used. If I subsequently find and recover it, I
will immediately return it to Passport Services at the address on the back of this form or to the nearest passport agency.
For Official Use Only
E-mail Address
Work Telephone Number
Sex
How, where and on what date did the loss or theft take place? If lost, what efforts were made to recover the passport?
List your lost or stolen passport numbers:
DS-64
03-2009
OMB No. 1405-0014
Expires: 04-30-2011
Estimated Burden: 5 Minutes*
2. LOST OR STOLEN PASSPORT INFORMATION
Page 1 of 2
List the date(s) your lost or stolen passport(s) were issued: (mm-dd-yyyy)
Female Male
Date
Home Telephone Number
( )( )
Signature
Answer all questions completely. If you do not know the answer in detail, be
as exact as possible.
(mm-dd-yyyy)
1. IDENTIFYING INFORMATION
Current Address (Street, City, State, and ZIP Code)
Please select the document (or documents) which you are reporting and its status.
U.S. Passport Book
U.S. Passport Card
Lost
Stolen
Lost
Stolen
Yes No
Passport
Card
Passport
Book
Passport
Card
Passport
Book
Protect yourself against identity theft! Report a lost or stolen passport book or passport card!
Type or print legibly in blue or black ink in white areas only.
HOW TO REPORT YOUR LOST OR STOLEN PASSPORT:
If you are applying for a new passport, please submit this form with the new passport
application to any designated acceptance facility, passport agency, or U.S. consular official.
If you are not currently applying for a new passport, send this form or a recovered lost or
stolen passport to the following address:
(Please do not attempt to use this address for any passport related service other than that
described above.)
U.S. Department of State
Passport Services
Consular Lost/Stolen Passport Section
Attn: CLASP
1111 19th Street, NW, Suite 500
Washington, DC 20036
To report your lost or stolen passport by phone, call: 202-955-0430
Or visit our website: www. travel.state.gov
PRIVACY ACT AND PAPERWORK REDUCTION ACT STATEMENTS
AUTHORITIES: The information solicited on this form is requested pursuant to provisions 22 U.S.C. 211a, et seq.;
Executive Order 11295 (August 5, 1966); Title 22, Part 51, Code of Federal Regulations (CFR); and in particular 22
CFR 51.2(b) and 51.8(b).
PURPOSE: The primary purpose for soliciting the information is to ensure that no person shall bear more than one
valid or potentially valid United States passport book and one valid passport card at any one time, except as
authorized by the U.S. Department of State, and to combat passport fraud and misuse.
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 requests for related
services, 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 also be made available to private U.S.
citizen 'wardens' designated by U.S. embassies and consulates.
CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: Except as noted, failure to provide the information
requested on this form may result in the denial of a United States passport, related documents, or service to the
individual seeking such passport, documents, or service. The disclosure of your social security number on this form
is voluntary and in accordance with the authorities listed above and will be used in the processing of your statement
regarding your lost or stolen passport and as described in the preceding paragraphs.
*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 and/or
documents required, and reviewing the final collection. You do not have to supply this information unless this
collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden
estimate and/or recommendations for reducing it, please sent them to: A/GIS/DIR, Room 2400 SA-22, U.S.
Department of State, Washington, DC 20522-2202.
DS-64
Page 2 of 2
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 the provisions of 18 U.S.C. 1001 and/or 18
U.S.C. 1542. Alteration or mutilation of a U.S. passport is punishable by fine and/or imprisonment under the
provisions of 18 U.S.C. 1543. The use of a U.S. 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.
WARNING
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Completed 9 January 2021

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