Form N-300 - Application To File, Declaration Of Intention Page 2
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Part 1. Information About You (Continued)
A
9. Daytime Phone Number
Work Phone Number (if any)
Evening Phone Number
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)
(
)
(
)
Mobile Phone Number (if any)
10.
E-Mail Address (if any)
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)
Part 2. Your Signature (USCIS will reject your Form N-300 if it is not signed.)
Read the information on penalties in the instructions before completing this section. You must be in the United States when you file
this application. You must sign your name below as well as in Part 4 and Part 5.
I desire to declare my intention to become a citizen of the United States. I certify, under penalty of perjury under the laws of the
United States of America, that this application and the evidence submitted with it is all true and correct. I authorize release of any
information from my records that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am
seeking.
Your Signature
Date (mm/dd/yyyy)
Part 3. Signature of Person Who Prepared This Form for You (if applicable)
I declare under penalty of perjury that I prepared this form at the request of the above person, and it is based on all information of
which I have any knowledge.
Preparer's Printed Name
Preparer's Signature
Date (mm/dd/yyyy)
Preparer's Firm or Organization Name (if applicable)
Preparer's Daytime Phone Number
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Preparer's Address
Street Number and Name
County
City
State
ZIP Code
Preparer's E-Mail Address (if any)
Preparer's Fax Number
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Form N-300 (03/21/13) N Page 2
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