Get DS-3053 2020-2021
U.S. Department of State STATEMENT OF CONSENT ISSUANCE OF A U.S. PASSPORT TO A MINOR UNDER AGE 16 USE OF THIS FORM The information collected on this form is used in conjunction with the DS-11 Application for a U.S. Passport. Authorize I Print Name non-applying parent/guardian Print Name person applying for minor s passport to apply for a United States passport for my minor child named on this application. My consent is unconditional in regards to passport validity and travel. Apartment Street Address non-applying parent City State Zip Code Area Code Telephone Number E-mail Address STOP YOU MUST SIGN THIS FORM IN FRONT OF A NOTARY. A clear photocopy of the front and back of the non-applying parent s government-issued photo identification presented to the notary is required with the written consent. 4. Please submit this form with your minor child s new DS-11 passport application to any designated acceptance facility U.S. Passport Agency U.S. Embassy or U.S. Consulate abroad. SPECIAL REQUIREMENTS FOR INSTITUTIONS/ENTITIES GRANTED GUARDIANSHIP Below is a list of documents you must submit with your DS-3053 1. If the required statement is not submitted the minor may not be eligible to receive a U.S. passport. The required statement may be submitted in other formats provided they meet statutory and regulatory requirements. FORM INSTRUCTIONS 1. Complete fields 1 2 and 3. If field 3 is not completed authorization will be valid for both products. FORM INSTRUCTIONS 1. Complete fields 1 2 and 3. If field 3 is not completed authorization will be valid for both products. child. NOTE Your signature must be witnessed and notarized in field 5. 3. The written consent from the non-applying parent that accompanies an application for a new U.S. passport must not be more than 90 days old. 4. Please submit this form with your minor child s new DS-11 passport application to any designated acceptance facility U.S. Passport Agency U.S. Embassy or U.S. Consulate abroad. SPECIAL REQUIREMENTS FOR INSTITUTIONS/ENTITIES GRANTED GUARDIANSHIP Below is a list of documents you must submit with your DS-3053 1. A certified order of a court of competent jurisdiction granting guardianship to the institution/entity. O. Box 1227 Sterling Virginia 20166-1227. DS-3053 08-2016 Page 1 of 2 OMB CONTROL NO. 1405-0129 OMB EXPIRATION DATE 08-31-2019 ESTIMATED BURDEN 20 Minutes Attention Read WARNING and FORM INSTRUCTIONS on Page 1 1. MINOR S NAME Last First 2. MINOR S DATE OF BIRTH mm/dd/yyyy Middle 3. THIS AUTHORIZATION IS VALID FOR Passport Book and Card Book Only Card Only present at the time the applying parent or guardian submits the minor s application. Statements expire after 90 days. When a minor under the age of 16 applies for a passport and one of the minor s parents or legal guardians is unavailable at the time the passport is executed a completed and notarized DS-3053 can be used as the statement of consent. If the required statement is not submitted the minor may not be eligible to receive a U*S* passport..
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