OMB No. 1615-0056 N-470, Application to Preserve Residence for Naturalization Purposes Department of Homeland Security U.S. Citizenship and Immigration Services START HERE - Please type or print in black ink. Part 1. For USCIS Use Only Returned Information about you. (Person filing this application) Family Name Given Name A Number (if any) Middle Name U.S. Social Security Number (if any) Home Address - Street Number and Name Apt. # City Date Date Resubmitted Date Date Reloc Sent State/Province Zip/Postal Code Receipt Country Date Mailing Address - Street Number and Name Apt. # Date Reloc Rec'd Date C/O (in care of): Date Remarks City State/Province Zip/Postal Code Country Daytime Phone # (Area/Country Code) Date of Birth (mm/dd/yyyy) Country of Birth Country of Citizenship Part 2. Reason for Request. My absence from the United States is: (Check one box) A. B. For the purpose of carrying on scientific research on behalf of an American institution of research. C. For the purpose of engaging in the development of foreign trade and commerce of the United States on behalf of an American firm or corporation or a subsidiary thereof. D. Necessary for the protection of property rights outside the United States of an American firm or corporation engaged in the development of foreign trade and commerce of the United States. E. On behalf of a public international organization of which the United States is a member. F. Solely because of my capacity as a clergyman or clergywoman, missionary, brother, nun or sister of a denomination or mission having a bona fide organization in the United States. Action Block On behalf of the U.S. Government. To Be Completed by Attorney or Representative, if any. Fill in box if G-28 is attached to represent the applicant. ATTY State License # Form N-470 (Rev. 01/31/11) Y American LegalNet, Inc. www.FormsWorkFlow.com Part 3. Additional information. 1. Give the date that you obtained lawful permanent resident status. (mm/dd/yyyy) 2. Since lawful entry as a permanent resident, have you resided in and been physically present in the United States for an Yes No uninterrupted period of at least 1 year? 3. List all you absences from the United States since your admission as a lawful permanent resident. Begin with your most recent trip. Date of Departure (mm/dd/yyyy) Date of Return (mm/dd/yyyy) Port of Entry Into the United States Purpose of Trip 4. Explain the position of employment that requires your absence from the United States and the intended length of employment. 5. Is the name you provided in Part 1 different from the name that appears on your Form I-551, Permanent No Yes Resident Card? If "Yes," note the information that is different. You must provide evidence showing the legal basis for the difference. 6. Since becoming a lawful permanent resident, have you ever filed an income tax return as a nonresident or otherwise claimed or received benefits as a nonresident alien under U.S. federal, state or local income tax laws? Yes No Are other family members who are lawful permanent residents intending to reside outside the United States 7. Yes with you? No Give the following information about other family members who will reside outside the United States with you. Name (Last/First/Middle) Date of Birth (mm/dd/yyyy) Relationship A Number (if applicable) Part 4. Signature. Read the information on penalties in the instructions before completing this part. I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with it is all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit sought. Signature of Applicant Daytime Phone Number (with area code) E-Mail Address (if any) Date (mm/dd/yyyy) NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be found eligible for the requested document and this application may be denied. Part 5. Signature of person preparing form, if other than above. (Sign below) I declare that I prepared this application at the request of the applicant and it is based on all information of which I have knowledge. Signature of Preparer Print or Type Your Name Firm Name and Address Daytime Phone Number (with area code) Date (mm/dd/yyyy) E-Mail Address (if any) Fax Number (if any) Form N-470 (Rev. 01/31/11) Y Page 2 American LegalNet, Inc. www.FormsWorkFlow.com