I do not hold any passport or other form of travel

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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 GLUE HERE ________________________________________________ AUTHORIZED OATH – ADMINISTERING OFFICIAL Clerk of Court Passport Agent Notary Public 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: Passport Bearer’s Name: Report of Birth: Marriage Certificate Court Decree: Name Change Naturalization Other: Seen & Returned: BC P ROB MC Attached: BC P ROB MC CD CD OTH: OTH: APPLICATION APPROVAL FOR PASSPORT OFFICE USE ONLY [ ]- REGULAR [ ] - OFFICIAL [ ] - DIPLOMATIC [ ] - EXTENSION [ ] - AMENDMENT [ ] - NEW PASSPORT PASSPORT NUMBER:_________________________ ISSUANCE DATE:_________...
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