Sample Form G-325a - Petitioner 243l6j
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OMB No. 1615-0008; Expires 06/30/2011
Department of Homeland Security U.S. Citizenship and Immigration Services
(Family Name)
G-325A, Biographic Information
(First Name)
WASHINGTON
MARK
Date of Birth (mm/dd/yyyy)
Male
(Middle Name)
GEORGE
07/17/1975
Female
All Other Names Used (include names by previous marriages)
Citizenship/Nationality File Number
A NONE
USA
U.S. Social Security # (if any)
City and Country of Birth
NONE
111-11-1111
LOS ANGELES USA Family Name
First Name
Father WASHINGTON Mother (Maiden Name) JEFFERSON Current Husband or Wife (If none, so state) Family Name (For wife, give maiden name)
DOE
Date of Birth (mm/dd/yyyy)
City, and Country of Birth (if known)
City and Country of Residence
MICHAEL
09/27/1940
SACRAMENTO USA
LOS ANGELES USA
MARTHA
05/17/1941
CHICAGO USA
LOS ANGELES USA
First Name
Date of Birth (mm/dd/yyyy)
JANE
07/30/1976 PENANG MALAYSIA 12/15/2010 PENANG MALAYSIA
Former Husbands or Wives (If none, so state) First Name Family Name (For wife, give maiden name)
City and Country of Birth
Date of Birth (mm/dd/yyyy)
Date and Place of Marriage
Date of Marriage Place of Marriage
Date and Place of Termination of Marriage
NONE
N/A
N/A
N/A
N/A
NONE
N/A
N/A
N/A
N/A
Applicant's residence last five years. List present address first. Street and Number
City
Province or State
Country
From Month Year
To Month
Year
11 PENANG ROAD
GEORGE TOWN
PENANG
MALAYSIA
MAR
2010
11 SINGAPORE ROAD
SINGAPORE
SINGAPORE
SINGAPORE
APR
2006
MAR
2010
11 CALIFORNIA ROAD
LOS ANGELES
CALIFORNIA
USA
FEB
2005
APR
2006
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Present Time
Applicant's last address outside the United States of more than 1 year. Street and Number
City
11 PENANG ROAD
GEORGE TOWN
Province or State
PENANG
Country
MALAYSIA
From Month Year
MAR
To Month
Year
2010
Applicant's employment last five years. (If none, so state.) List present employment first. Full Name and Address of Employer
Occupation (Specify)
From Month Year
To Month
Year
PENANG INCORPORATED
MANAGER
MAR
2010
SINGAPORE INCORPORATED
MANAGER
APR
2006
MAR
2010
LOS ANGELES INCORPORATED
STAFF
FEB
2005
APR
2006
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Present Time
Last occupation abroad if not shown above. (Include all information requested above.) INCLUDED ABOVE This form is submitted in connection with an application for: Naturalization
Date
Signature of Applicant
Other (Specify): FORM I-130
01/20/2011
Status as Permanent Resident If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
N/A
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.
Applicant: Print your name and Alien Registration Number in the box outlined by heavy border below. Complete This Box (Family Name)
WASHINGTON
(Given Name)
MARK
(Middle Name)
GEORGE
(Alien Registration Number)
A NONE Form G-325A (Rev. 06/12/09)Y
Department of Homeland Security U.S. Citizenship and Immigration Services
(Family Name)
G-325A, Biographic Information
(First Name)
WASHINGTON
MARK
Date of Birth (mm/dd/yyyy)
Male
(Middle Name)
GEORGE
07/17/1975
Female
All Other Names Used (include names by previous marriages)
Citizenship/Nationality File Number
A NONE
USA
U.S. Social Security # (if any)
City and Country of Birth
NONE
111-11-1111
LOS ANGELES USA Family Name
First Name
Father WASHINGTON Mother (Maiden Name) JEFFERSON Current Husband or Wife (If none, so state) Family Name (For wife, give maiden name)
DOE
Date of Birth (mm/dd/yyyy)
City, and Country of Birth (if known)
City and Country of Residence
MICHAEL
09/27/1940
SACRAMENTO USA
LOS ANGELES USA
MARTHA
05/17/1941
CHICAGO USA
LOS ANGELES USA
First Name
Date of Birth (mm/dd/yyyy)
JANE
07/30/1976 PENANG MALAYSIA 12/15/2010 PENANG MALAYSIA
Former Husbands or Wives (If none, so state) First Name Family Name (For wife, give maiden name)
City and Country of Birth
Date of Birth (mm/dd/yyyy)
Date and Place of Marriage
Date of Marriage Place of Marriage
Date and Place of Termination of Marriage
NONE
N/A
N/A
N/A
N/A
NONE
N/A
N/A
N/A
N/A
Applicant's residence last five years. List present address first. Street and Number
City
Province or State
Country
From Month Year
To Month
Year
11 PENANG ROAD
GEORGE TOWN
PENANG
MALAYSIA
MAR
2010
11 SINGAPORE ROAD
SINGAPORE
SINGAPORE
SINGAPORE
APR
2006
MAR
2010
11 CALIFORNIA ROAD
LOS ANGELES
CALIFORNIA
USA
FEB
2005
APR
2006
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Present Time
Applicant's last address outside the United States of more than 1 year. Street and Number
City
11 PENANG ROAD
GEORGE TOWN
Province or State
PENANG
Country
MALAYSIA
From Month Year
MAR
To Month
Year
2010
Applicant's employment last five years. (If none, so state.) List present employment first. Full Name and Address of Employer
Occupation (Specify)
From Month Year
To Month
Year
PENANG INCORPORATED
MANAGER
MAR
2010
SINGAPORE INCORPORATED
MANAGER
APR
2006
MAR
2010
LOS ANGELES INCORPORATED
STAFF
FEB
2005
APR
2006
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Present Time
Last occupation abroad if not shown above. (Include all information requested above.) INCLUDED ABOVE This form is submitted in connection with an application for: Naturalization
Date
Signature of Applicant
Other (Specify): FORM I-130
01/20/2011
Status as Permanent Resident If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
N/A
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.
Applicant: Print your name and Alien Registration Number in the box outlined by heavy border below. Complete This Box (Family Name)
WASHINGTON
(Given Name)
MARK
(Middle Name)
GEORGE
(Alien Registration Number)
A NONE Form G-325A (Rev. 06/12/09)Y
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