Form Ds-5507 - Affidavit Of Parentage, Physical Presence And Support
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5U. S. Department of State
OMB NO. 1405-0187
EXPIRES - 6/30/2012
CONSULAR OFFICES OF THE UNITED STATES OF AMERICA
Estimated Burden - 30 minutes
AFFIDAVIT OF PARENTAGE, PHYSICAL PRESENCE AND SUPPORT
PART I
(All applicants please complete Part I)
I,
do solemnly swear (or affirm):
Name
(choose one)
That I am a U.S. citizen/U.S. non-citizen national by:
1) birth in
on
City/Town, State
Date
(mm-dd-yyyy)
2) naturalization on
before the
Date
(mm-dd-yyyy)
Name of Court
3) birth abroad on
to U.S. citizen(s) or U.S. non-citizen national(s) in
Date (mm-dd-yyyy)
Country
Married
Previously Married
That I am
(choose one)
married on
to
Date
(mm-dd-yyyy)
Name
in
or
Not Married
Country
That I am the biological parent of:
Date of Birth
(mm-dd-yyyy)
Name of Child
Place of Birth
(Continue on a separate sheet, if necessary)
DS-5507
Page 1 of 5
(Continued on the next page)
06-2009
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