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Form DS 3032

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OMB No.

1405-0126
Make sure the address is complete and correct. We will use this address for future mailings. EXPIRATION DATE: 12/31/2006
ESTIMATED BURDEN: 30 minutes*

Place Case Barcode Strip Here Before Mailing to the National Visa Center

U.S. Department of State


CHOICE OF ADDRESS AND AGENT
For Immigrant Visa Applicants

Print or type your full name


Check one box only to the left of the statement that is your choice.

I appoint:
as my agent or attorney to receive mail about my application. Mail from the U. S. Department of State concerning
my immigrant visa application should be sent to:

Name of the person who will act as your agent or attorney for receipt of mail

Street address (where my agent or attorney will receive mail about my application)

City State/Province Postal Code Country

I do not appoint an agent or an attorney to receive mail about my application. Mail from the U.S. Department of
State concerning my immigrant visa application should be sent to me at:

Street address (include "in care of" if needed)

City State/Province Postal Code Country

I have already legally immigrated to the U. S. and do not need to apply for an immigrant visa.

I no longer wish to apply for an immigrant visa.

As proof of your choice, sign and date this document:

Signature of Applicant Date of Signature

PAPERWORK REDUCTION ACT

*Public reporting burden for this collection of information is estimated to average 30 minutes per response. Persons are not required to
provide this information in the absence of a valid OMB approval number. Send comments on the accuracy of this estimate of the burden and
recommendations for reducing it to: U.S. Department of State (A/RPS/DIR) Washington, DC 20520-1849.

DS-3032
12-2003

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