Get Affidavit of Residence and Paternity/Maternity 2012-2024

AFFIDAVIT OF RESIDENCE AND PATERNITY/MATERNITY I solemnly swear or affirm that the following statements are true and complete to the best of my knowledge and belief. I acknowledge that the purpose of this Affidavit is the establishment of my relationship to persons claiming U.S. citizenship entitlement to visas or federal benefits. Name Last First Date of Birth Middle Month / Day / Year Social Security No* Local Telephone No* If you are a U*S* citizen please complete the following I became a U*S* citizen by Birth in the U*S* Born American Outside U*S* Naturalization Passport or Naturalization Certificate No Date Issued Place 1. What is your occupation 2. Have you ever been outside the U*S* as an employee or as the dependent of an employee of the U*S* government or an international organization YES NO If YES list the agency or organization and the dates abroad as an employee or dependent of an employee Organization Name 3. Have you worked as a seaman Dates Abroad If yes provide all of your discharge slips and fill in the blank below. I have been working as a seaman since. 4. I have been physically present in the United States as follows Please bring your current and all previous passports or other evidence such as cancelled passports tax returns letters from former employers with specific dates of employment old pay stubs cancelled checks school transcripts report cards medical records discharge slips receipts or any other type of documentation that shows the date and required your signature. FOR OFFICE USE FROM TO TYPE OF MONTH/DAY/YEAR EVIDENCE Revised 5/29/12 5. List present and all previous spouses SPOUSE S NAME OF BIRTH DATE OF MARRIAGE DIVORCE DATE OF DEATH 6. Has any one of your spouses been previously married YES NAME OF HIS/HER PREVIOUS SPOUSE NO If yes please complete the table below. DATE OF BIRTH DATE AND REASON FOR TERMINATION OF MARRIAGE 7. Please list ALL your children including natural step- and adopted children whether living or deceased* CHILD S FIRST NAME FATHER S MOTHER S GENDER M/F PLACE OF Warning False statements made knowingly and willfully in passport applications affidavits or other supporting documents are punishable by fine and/or imprisonment under the provisions of U*S*C. Sections 1001 and 1542. Signature of Affiant Subscribed and sworn before me on at Notary Public or US Consular Officer. Name Last First Date of Birth Middle Month / Day / Year Social Security No* Local Telephone No* If you are a U*S* citizen please complete the following I became a U*S* citizen by Birth in the U*S* Born American Outside U*S* Naturalization Passport or Naturalization Certificate No Date Issued Place 1. What is your occupation 2. Have you ever been outside the U*S* as an employee or as the dependent of an employee of the U*S* government or an international organization YES NO If YES list the agency or organization and the dates abroad as an employee or dependent of an employee Organization Name 3. What is your occupation 2. Have you ever been outside the U*S* as an employee or as the dependent of an employee of the U*S* government or an international organization YES NO If YES list the agency or organization and the dates abroad as an employee or dependent of an employee Organization Name 3. Have you worked as a seaman Dates Abroad If yes provide all of your discharge slips and fill in the blank below. .