Fill and Sign the Naturalized Citizenship 497330752 Form

Affidavit of Naturalized Citizen Given to Prove Loss of Passport State of __________________________ County of ________________________ ________________________ (Name of Affiant) , being first duly sworn, deposes and says: 1 . I reside at _____________________________________________________________ (address of affiant) , __________________ (name of city) , ___________________ (name of county) , __________________ (name of state) . 2. I was born on _____________________ (date of birth) at _____________________ (name of city) , _______________________ (name of state or province) , _________________________ (name of country) . 3. On ____________________ (date of issuance of certificate of naturalization ) , I was issued Certificate of Naturalization No. ___________________ (certificate of naturalization number) . 4. I was issued a United States passport on _________________ (date of issuance of passport) , at _____________________________________ (location of issuance of passport) . My passport number is _________________ (passport number) . 5. I last saw my passport at ______________________________ (place where passport last seen) on or about _____________________ (date when passport last seen) . 6. My passport was ______________ (lost or destroyed) under the following circumstances: (description of circumstances of loss or destruction) ____________ ______________________________________________________________________. 7. Notwithstanding diligent efforts on my part to find my passport I have not been able to find said passport. 8. This Affidavit is executed to obtain a new passport to replace the one that was __________________ (lost or destroyed) . ________________________________ (Signature of Affiant) ________________________________ (Print or Type Name) SWORN to and subscribed before me, this the ______ day of ______________, 20______. __________________________ NOTARY PUBLIC My Commission Expires: _________________________