Statement Of Consent Issuance Of A US Passport To A Child Form DS 3053

Information you will need

• Is the minor child under 16?
• Is this form to provide consent for a passport book, passport card, or both?
• What's the child’s last name?
• What's the child’s first name?
• What's the child’s middle name? (if applicable)
• What’s the child’s date of birth?
• What’s the name of the parent or guardian applying with the child?
• What’s the parent or guardian’s street address?
• What’s the parent or guardian’s apartment number? (If applicable)
• What’s the parent or guardian’s city?
• What’s the parent or guardian’s state?
• What’s the parent or guardian’s ZIP code?
• What’s the parent or guardian’s area code?
• What’s the parent or guardian’s telephone number?
• What’s the parent or guardian’s email address?
• What’s the name of the parent or guardian filling out this form?

Completed by the affiant.

The form includes a notary acknowledgment.