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Unformatted text preview: , state or sovereignty other than the
United States. I do not hold any passport or other form of travel document issued to me by any foreign state or sovereign, except for the United States.
DECLARATION: I declare that the statements made in this application are true and complete to the best of my knowledge and belief, that the attached photographs
are a true likeness of me.
Signature of Applicant: SIGN INSIDE THIS BOX
Month Day Year Month Day Year 2”X2” PHOTO
Subscribed and sworn to (affirmed) before me
AUTHORIZED OATH – ADMINISTERING OFFICIAL
Clerk of Court
Palau Consular Serv.; Location/Title:
DO NOT WRITE BELOW THIS SPACE FOR PASSPORT SERVICES USE ONLY SEAL DO NOT WRITE BELOW THIS Applicants evidence of citizenship
Birth Certificate Filed/Issued:
Report of Birth:
Seen & Returned: BC
OTH: APPLICATION APPROVAL FOR PASSPORT OFFICE USE ONLY
[ ]- REGULAR [ ] - OFFICIAL [ ] - DIPLOMATIC [ ] - EXTENSION [ ] - AMENDMENT [ ] - NEW PASSPORT PASSPORT NUMBER:_________________________ ISSUANCE DATE:_________...
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- Fall '14