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Get DS-4080 2013-2024

, Name (Print Full Name) solemnly swear/affirm that I was born at , (City or Town) , , on (State or Country) (Province or County) Date (mm-dd-yyyy) That I formerly resided in the United States at: (Street Address) (City, State and ZIP Code) That I am a national of the United States by virtue of: Birth in United States or Abroad to U.S. Parent(s) Naturalization Date of Naturalization Date (mm-dd-yyyy) (If naturalized, give the name and place of the court in the United States before whic.

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