Form N-470 (2010) Application To Preserve Residence For Naturalization Purposes
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2OMB No. 1615-0056; Expires 01/31/2011
N-470, Application to Preserve
Department of Homeland Security
Residence for Naturalization Purposes
U.S. Citizenship and Immigration Services
START HERE - Please type or print in black ink.
For USCIS Use Only
Returned
Receipt
Part 1.
Information about you.
(Person filing this application)
Family Name
Given Name
Middle Name
Date
Date
U.S. Social Security Number (if any)
A Number (if any)
Resubmitted
Date
Home Address - Street Number and Name
Apt. #
Date
Reloc Sent
City
State/Province
Date
Zip/Postal Code
Country
Date
Reloc Rec'd
Mailing Address - Street Number and Name
Apt. #
Date
C/O (in care of):
Date
Remarks
City
State/Province
Zip/Postal Code
Country
Daytime Phone # (Area/Country Code)
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship
Part 2. Reason for Request.
:
My absence from the United States is
(Check one box)
Action Block
A.
On behalf of the U.S. Government.
B.
For the purpose of carrying on scientific research on behalf of an American
institution of research.
C.
For the purpose of engaging in the development of foreign trade and commerce
of the United States on behalf of an American firm or corporation or a
subsidiary thereof.
D.
Necessary for the protection of property rights outside the United States of an
American firm or corporation engaged in the development of foreign trade and
commerce of the United States.
To Be Completed by
E.
On behalf of a public international organization of which the United States is a
Attorney or Representative, if any.
member.
Fill in box if G-28 is attached
to represent the applicant.
F.
Solely because of my capacity as a clergyman or clergywoman, missionary,
brother, nun or sister of a denomination or mission having a bona fide
ATTY State License #
organization in the United States.
Form N-470 (Rev. 01/06/2010) N
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