OMB No.

1615-0008; Expires 06/30/2011

Department of Homeland Security
U.S. Citizenship and Immigration Services G-325A, Biographic Information

(Family Name) (First Name) (Middle Name) Male Date of Birth Citizenship/Nationality File Number
(mm/dd/yyyy)
WASHINGTON MARK GEORGE Female 07/17/1975 USA A NONE
All Other Names Used (include names by previous marriages) City and Country of Birth U.S. Social Security # (if any)
NONE LOS ANGELES USA 111-11-1111

Family Name First Name Date of Birth City, and Country of Birth City and Country of Residence
(mm/dd/yyyy) (if known)

Father WASHINGTON MICHAEL 09/27/1940 SACRAMENTO USA LOS ANGELES USA

Mother
(Maiden Name) JEFFERSON MARTHA 05/17/1941 CHICAGO USA LOS ANGELES USA
Current Husband or Wife (If none, so state) First Name Date of Birth City and Country of Birth Date of Marriage Place of Marriage
Family Name (For wife, give maiden name) (mm/dd/yyyy)
DOE JANE 07/30/1976 PENANG MALAYSIA 12/15/2010 PENANG MALAYSIA
Former Husbands or Wives (If none, so state) First Name Date of Birth Date and Place of Marriage Date and Place of Termination of
Family Name (For wife, give maiden name) (mm/dd/yyyy) 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.
From To
Street and Number City Province or State Country
Month Year Month Year
11 PENANG ROAD GEORGE TOWN PENANG MALAYSIA MAR 2010 Present Time

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

Applicant's last address outside the United States of more than 1 year.
From To
Street and Number City Province or State Country
Month Year Month Year
11 PENANG ROAD GEORGE TOWN PENANG MALAYSIA MAR 2010

Applicant's employment last five years. (If none, so state.) List present employment first.
From To
Full Name and Address of Employer Occupation (Specify)
Month Year Month Year
PENANG INCORPORATED MANAGER MAR 2010 Present Time
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
Last occupation abroad if not shown above. (Include all information requested above.)
INCLUDED ABOVE
This form is submitted in connection with an application for: Signature of Applicant Date
Naturalization 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) (Given Name) (Middle Name) (Alien Registration Number)
WASHINGTON MARK GEORGE A NONE
Form G-325A (Rev. 06/12/09)Y