PersonalInformation1OMBCONTROLNUMBER:1405-0185FORMNUMBER:DS-260EXPIRATIONDATE:01/31/2016ESTIMATEDBURDEN:120MINNOTE:Dataonthispagemustmatchtheinformationasitiswritteninyourpassportortraveldocuments
SurnamesGivenNamesFullNameinNativeAlphabetHaveyoueverusedothernames(i
,maiden,religious,professional,alias,etc
(yes)(no)Sex(male)female)CurrentMaritalStatusDateofBirth(Format:DD-MMM-YYYY)CityofBirthState/ProvinceofBirthCountry/RegionofBirthPersonalInformation2Country/RegionofOrigin(Nationality)DocumentTypeDocumentIDCountry/AuthoritythatIssuedDocumentIssuanceDate(Format:DD-MMM-YYYY)ExpirationDate(Format:DD-MMM-YYYY)Doyouholdorhaveyouheldanynationalityotherthantheoneyouhaveindicatedabove
(yes)(no)PresentAddressStreetAddress(Line1)StreetAddress(Line2)*OptionalCityState/ProvincePostalZone/ZIPCode