Passport Agency

Federal Building, Room 13100
11000 Wilshire Boulevard
                                                                       Los Angeles, California, 90024-3615

Request for Renewal of a Second Passport 

I (name) _____________________________________________________, am the bearer of full validity U.S. Passport number ____________________________ issued on ________________, and a second limited US Passport number _______issued on _____________.  However, in view of the restrictive entry policies and/or the time delay in obtaining visas it is impossible to complete my trip using one passport. 

I am traveling to _____________________ which denies entry to_________.  I am therefore requesting extension of the validity of my limited passport for a further two years. This second passport is needed because______________________________________________________________________________________________________________________________

Should either passport be lost or stolen, I will immediately report the circumstances of the loss to Passport Services, or if abroad, to the nearest United States Embassy or Consulate. 

Signature ____________________ _____            Date ___________________