Affidavit of Parentage and Physical Presence
I, ................................................., do solemnly swear (or affirm):
That I am an American citizen by: (choose one)
1) birth in (city/town, state) .....................................................
on (date) ...................................................
2) naturalization on (date) .................................
before the (name of court) ................................................................
3) birth abroad on (date) ............................. to American parent(s)
That I have been physically present in the United States as follows:
PLACE (CITY, STATE) DATE (MONTH/DAY/YEAR) DATE (MONTH/DAY/YEAR)
................................. From ....................... To ...............................
................................. From ....................... To ...............................
................................. From ....................... To ...............................
................................. From ....................... To ...............................
................................. From ....................... To ...............................
................................. From ....................... To ...............................
(Continue on separate sheet, if necessary.)
That I have been physically present abroad as follows:
PLACE (CITY, COUNTRY) DATE (MONTH/DAY/YR) DATE (MONTH/DAY/YR) PURPOSE*
......................... From ................ To .................. ...................
......................... From ................ To .................. ...................
......................... From ................ To .................. ...................
......................... From ................ To .................. ...................
......................... From ................ To .................. ...................
......................... From ................ To .................. ...................
......................... From ................ To .................. ...................
......................... From ................ To .................. ...................
(*Indicate purpose of trip: vacation, residence, business, studies, U.S. military
service, U.S. military dependent, etc. If working abroad, give name of employer.
(Continue on separate sheet, if necessary.)
-2-
That my Social Security Number is ........................................;
My Military service number (if applicable) is ........................................;
That I have served in the United States Armed Forces from
..................................... to .....................................
(date) (date)
That I was married on .......................... at ..........................
(date) (place)
to ..............................................................
(name of spouse)
That, to the best my knowledge, I am the natural father/mother of the following
children:
NAME DATE OF BIRTH PLACE OF BIRTH
.............................. ........................ ..............................
.............................. ........................ ..............................
.............................. ........................ ..............................
.............................. ........................ ..............................
.............................. ........................ ..............................
.............................. ........................ ..............................
.............................. ........................ ..............................
.............................. ........................ ..............................
(Continue on separate sheet, if necessary.)
That the other parent of the above-named child/children is ........................................................................................ (name) whom I first met on ................................... at .......................... (date) (city, state or country) That, if any child named above was born out of wedlock and I am the father through whom such child is claiming United States citizenship, I agree to provide financial support for such child until such child reaches the age of eighteen years.* *NOTE: The preceding phrase may be deleted; however, if it is deleted by a United States citizen who fathered a child born out of wedlock to a foreign woman, the child will not be eligible for United States citizenship under Section 309(a) of the Immigration and Nationality Act, as amended on November 14, 1986.
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