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G Address First name 2 Street address, apt. number, or rural route number. If you have a P.O. box, see instructions. Middle name Last name City or town, state, and ZIP code 3 Citizenship and Identification Information 5 Date of birth (mm/dd/yyyy) 4 Country of birth Name at birth (if different from above) First name Birth Information Middle name Last name Citizenship and identification document(s) submitted (see instructions) Passport/Passport Card U.S. Driver s License Voter's.

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