#22 and #23: previous marriage information. m date of birth 01 / 01 / california s. oate 01 / / 1980...

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#22 and #23: Previous marriage information.

#24 and #25: Time spent in the United States: List all dates you have been present in the United States. (e.g. If you were born in the U.S., start from the date you were born until the date you left the U.S.)

#28: If you are a U.S. citizen father NOT married to the

mother at the time of child’s birth this section

MUST be completed.

#26 and #27: Parents’ periods abroad serving in U.S. Armed Forces, other

U.S. Government employment, or as a

dependent child.

Do not sign yet!

Page 4: #22 and #23: Previous marriage information. m Date of Birth 01 / 01 / California s. oate 01 / / 1980 (year' PhysÉal p. O. Box) O _ Address ... this address if Consular of Birth be

Do not sign yet!

Page 5: #22 and #23: Previous marriage information. m Date of Birth 01 / 01 / California s. oate 01 / / 1980 (year' PhysÉal p. O. Box) O _ Address ... this address if Consular of Birth be

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