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U.S. Department of State 
Passport Application (DSP-11) 
Bureau of Consular Affairs 
                        UNITED STATES DEPARTMENT OF STATE 
                               PASSPORT APPLICATION 
Section 6039E of the Internal Revenue Code of 1986 requires a passport 
applicant to provide his/her name (#1), mailing address (#2), date of 
birth (#5), and social security number (#6). If you have not been issued 
a social security number, enter zeroes in box #6.  Passport Services 
will provide this information to the Internal Revenue Service routinely.  
Any applicant who fails to provide the required information is subject 
to a $500 penalty enforced by the IRS.  All questions on this matter 
should be referred to the nearest IRS office. 
(If any of the below-mentioned acts or conditions has been performed by 
or applies to the applicant, the portion which applies should be lined 
out and a supplementary explanatory statement under oath (or 
affirmation) by the applicant should be attached and made a part of this 
I have not, since acquiring United States citizenship, been naturalized 
as a citizen of a foreign state; taken an oath or made an affirmation or 
other formal declaration of allegiance to a foreign state; entered or 
served in the armed forces of a foreign state; accepted or performed the 
duties of any office, post, or employment under the government of a 
foreign state or political subdivision thereof; made a formal 
renunciation of nationality either in the United States or before a 
diplomatic or consular officer of the United States in a foreign state; 
or been convicted by a court or court martial of competent jurisdiction 
of committing any act of treason against, or attempting by force to 
overthrow, or bearing arms against, the United States or conspiring to 
overthrow, put down, or to destroy by force, the Government of the 
United States; or having been naturalized, within one year after such 
naturalization, returned to the country of my birth or any other foreign 
country to take up a permanent residence. 
WARNING: False statements made knowingly and willfully in passport 
applications or in affidavits or other supporting documents submitted 
therewith are punishable by fine and/or imprisonment under provisions of 
18 USC 1001 and/or 18 USC 1542.  Alteration or mutilation of a passport 
issued pursuant to this application is punishable by fine and/or 
imprisonment under the provisions of 18 USC 1543.  The use of a passport 
in violation of the restrictions contained therein or of the passport 
regulations is punishable by fine and/or imprisonment under 18 USC 1544.  
All statements and documents submitted are subject to verification. 
The information solicited on this form is authorized by, but not limited 
to those statutes codified in Titles 8, 18, and 22, United States Code, 
and all predecessor statutes whether or not codified, and all 
regulations issued pursuant to Executive Order 11295 of August 5, 1966.  
The primary purpose for soliciting the information is to establish 
citizenship, identity, and entitlement to issuance of a United States 
Passport or related facility, and to properly administer and enforce the 
laws pertaining thereto. 
The information is made available as a routine use on a need-to-know 
basis to personnel of the Department of State and other government 
agencies having statutory or other lawful authority to maintain such 
information in the performance of their official duties, pursuant to a 
court order, and as set forth in Part 171, Title 22, Code of Federal 
Regulations (see Federal Register, Volume 42, pages 49791 through 
Failure to provide the information requested on this form may result in 
the denial of a United States Passport, related document, or service to 
the individual seeking such passport, document, or service. 
HOW TO APPLY FOR A U.S. PASSPORT.  U.S. passports are issued only to 
U.S. citizens or nationals.  Each person must obtain his or her own 
IF YOU ARE A FIRST-TIME APPLICANT, please complete and submit this 
application in person.  (Applicants under 13 years of age usually need 
not appear in person unless requested.  A parent or guardian may execute 
the application on the child's behalf.) Each application must be 
accompanied by (l) PROOF OF U.S. CITIZENSHIP, (2) PROOF OF IDENTITY, (3) 
TWO PHOTOGRAPHS, (4) FEES (as explained below) to one of the following 
acceptance agents: a clerk of any Federal or State court of record or a 
judge or clerk of any probate court accepting applications; a designated 
postal employee at a selected post office, or an agent at a Passport; 
Agency in Boston, Chicago, Honolulu, Houston, Los Angeles, Miami, New 
Orleans, New York, Philadelphia, San Francisco, Seattle, Stamford, or 
Washington, D.C.; or a U.S. consular official. 
IF YOU HAVE HAD A PREVIOUS PASSPORT, inquire about eligibility to use 
Form DSP-82 (mail-in application). 
Address requests for passport amendment, extension of validity, or 
additional visa pages to a Passport Agency or a U.S. Consulate or 
Embassy abroad.  Check visa requirements with consular officials of 
countries to be visited well in advance of your departure. 
STATES.  Submit previous U.S. passport or certified birth certificate.  
A birth certificate must include your given name and surname, date and 
place of birth, date the birth record was filed, and seal or other 
certification of the official custodian of such records.  A record filed 
more than I year after the birth is acceptable if it is supported by 
evidence described in the next paragraph. 
IF NO BIRTH RECORD EXISTS, submit registrar's notice to that effect.  
Also submit an early baptismal or circumcision certificate, hospital 
birth record, early census, school, or family Bible records, newspaper 
or insurance files, or notarized affidavits of persons having knowledge 
of your birth (preferably with at least one record listed above). 
Evidence should include your given name and surname, date and place of 
birth, and seal or other certification of office (if customary) and 
signature of issuing official. 
passport or Certificate of Naturalization, or Certificate of 
Citizenship, or a Report of Birth Abroad, or evidence described below. 
Certificate(s) of Naturalization of your parent(s) your foreign birth 
certificate, and proof of your admission to the United States for 
permanent residence. 
submit a Consular Report of Birth (Form FS-240) or Certification of 
Birth (Form DS-1350 or FS-545), or your foreign birth certificate, 
parents' marriage certificate, proof of citizenship of your parent(s), 
and affidavit of U.S. citizen parent(s) showing all periods and places 
of residence/physical presence in the United States and abroad before 
your birth. 
(2) PROOF OF IDENTITY.  If you are not personally known to the 
acceptance agent, you must establish your identity to the agent's 
satisfaction.  You may submit items such as the following containing 
your signature AND physical description or photograph that is a good 
likeness of you: previous U.S. passport; Certificate of Naturalization 
or of Citizenship; driver's license (not temporary or learner's license, 
or government (Federal, State, municipal) identification card or pass.  
Temporary or altered documents are not acceptable. 
IF YOU CANNOT PROVE YOUR IDENTITY as stated above, you must appear with 
an IDENTIFYING WITNESS who is a U.S. citizen or permanent resident alien 
who has known you for at least 2 years.  Your witness must prove his or 
her identity and complete and sign an Affidavit of Identifying Witness 
(Form DSP-71) before the acceptance agent.  You must also submit some 
identification of your own. 
(3) TWO PHOTOGRAPHS.  Submit two identical photographs of you alone, 
sufficiently recent to be a good likeness (normally taken within the 
last 6 months), 2 x 2 inches in size, with an image size from bottom of 
chin to top of head (including hair) of between 1 and 1-3/8 inches.  
Photographs must be clear, front view, full face, taken in normal street 
attire without a hat or dark glasses, and printed on thin paper with a 
plain light (white or off-white) background.  They may be black and 
white or color.  They must be capable of withstanding a mounting 
temperature of 225 Fahrenheit (107 Celsius). Photographs retouched so 
that your appearance is changed are unacceptable.  Snapshots, most 
vending machine prints, and magazine or full-length photographs are 
(4) FEES.  Submit $65 if you are 18 years of age or older.  The passport 
fee is $55.  In addition, a fee of $10; lO is charged for the execution 
of the application.  Your passport will be valid for 10 years from the 
date of issue except where limited by the Secretary of State to a 
shorter period.  Submit $40 if you are under 18 years of age.  The 
passport fee is $30 and the execution fee is $10.  Your passport will be 
valid for 5 years from the date of issue, except where limited as above. 
Pay the passport and execution fees in one of the following forms: 
checks-personal, certified, traveler's, bank draft or cashier's check, 
money order, U.S. Postal, international, currency exchange; or if 
abroad, the foreign currency equivalent, or a check drawn on a U.S. 
Make passport and execution fees payable to Passport Services (except if 
applying at a State court, pay execution fee as the State court 
requires) or the appropriate Embassy or Consulate if abroad.  No fee is 
charged to applicants with U.S. Government or military authorization for 
no-fee passports (except State courts may collect the execution fee). 
Pay special postage if applicable. 
FORM DSP-11, 12-87 
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