Download:
pdf |
pdfOMB No. 1615-0052
N-400 Application
for Naturalization
Department of Homeland Security
U.S Citizenship and Immigration Services
Print clearly or type your answers using CAPITAL letters. Failure to print clearly may delay your application. Use black ink.
Write your USCIS ''A''- number here:
A
Part 1. Your Name. (The Person Applying for Naturalization)
A. Your current legal name.
Family Name (Last Name)
For USCIS Use Only
Bar Code
Given Name (First Name)
Date Stamp
Full Middle Name (If applicable)
B. Your name exactly as it appears on your Permanent Resident Card.
Family Name (Last Name)
Given Name (First Name)
Remarks
Full Middle Name (If applicable)
C. If you have ever used other names, provide them below.
Family Name (Last Name)
Given Name (First Name)
Middle Name
D. Name change (optional)
Please read the Instructions before you decide whether to change your name.
1. Would you like to legally change your name?
Yes
No
2. If ''Yes," print the new name you would like to use. Do not use initials or
abbreviations when writing your new name.
Action Block
Family Name (Last Name)
Given Name (First Name)
Full Middle Name
Part 2. Information About Your Eligibility. (Check Only One)
I am at least 18 years old AND
A.
I have been a Lawful Permanent Resident of the United States for at least five years.
B.
I have been a Lawful Permanent Resident of the United States for at least three years, and I
have been married to and living with the same U.S. citizen for the last three years, and my
spouse has been a U.S. citizen for the last three years.
C.
I am applying on the basis of qualifying military service.
D.
Other (Please explain)
Form N-400 (Rev. 10/26/05)Y
Write your USCIS ''A''- number here:
A
Part 3. Information About You.
A. U.S. Social Security Number
B. Date of Birth (mm/dd/yyyy)
D. Country of Birth
C. Date You Became a Permanent Resident (mm/dd/yyyy)
E. Country of Nationality
F. Are either of your parents U.S. citizens? (if yes, see Instructions)
Yes
No
G. What is your current marital status?
Married
Divorced
Single, Never Married
Widowed
Marriage Annulled or Other (Explain)
H. Are you requesting a waiver of the English and/or U.S. History and Government
requirements based on a disability or impairment and attaching a Form N-648 with
your application?
I. Are you requesting an accommodation to the naturalization process because of a
disability or impairment? (See Instructions for some examples of accommodations.)
Yes
No
Yes
No
If you answered ''Yes," check the box below that applies:
I am deaf or hearing impaired and need a sign language interpreter who uses the following language:
I use a wheelchair.
I am blind or sight impaired.
I will need another type of accommodation. Please explain:
Part 4. Addresses and Telephone Numbers.
A. Home Address - Street Number and Name (Do not write a P.O. Box in this space)
City
County
B. Care of
City
)
ZIP Code
Country
Mailing Address - Street Number and Name (If different from home address)
State
C. Daytime Phone Number (If any)
(
State
Apartment Number
ZIP Code
Evening Phone Number (If any)
(
Apartment Number
Country
E-mail Address (If any)
)
Form N-400 (Rev. 10/26/05)Y Page 2
Write your USCIS ''A''- number here:
A
Part 5. Information for Criminal Records Search.
NOTE: The categories below are those required by the FBI. See Instructions for more information.
A. Gender
Male
B. Height
Female
D. Are you Hispanic or Latino?
C. Weight
Feet
Inches
Yes
No
Pounds
E. Race (Select one or more.)
White
Asian
Black or African
American
American Indian or Alaskan Native
Brown
Blonde
Gray
White
Red
Sandy
Bald (No Hair)
Blue
Green
Hazel
Gray
Black
Pink
Maroon
F. Hair color
Black
Native Hawaiian or
Other Pacific Islander
G. Eye color
Brown
Other
Part 6. Information About Your Residence and Employment.
A. Where have you lived during the last five years? Begin with where you live now and then list every place you lived for the last five
years. If you need more space, use a separate sheet(s) of paper.
Street Number and Name, Apartment Number, City, State, Zip Code and Country
Dates (mm/dd/yyyy)
From
To
Current Home Address - Same as Part 4.A
Present
B. Where have you worked (or, if you were a student, what schools did you attend) during the last five years? Include military service.
Begin with your current or latest employer and then list every place you have worked or studied for the last five years. If you need
more space, use a separate sheet of paper.
Employer or
School Name
Employer or School Address
(Street, City and State)
Dates (mm/dd/yyyy)
From
To
Your
Occupation
Form N-400 (Rev. 10/26/05)Y Page 3
Write your USCIS ''A"- number here:
A
Part 7. Time Outside the United States.
(Including Trips to Canada, Mexico and the Caribbean Islands)
A. How many total days did you spend outside of the United States during the past five years?
days
B. How many trips of 24 hours or more have you taken outside of the United States during the past five years?
trips
C. List below all the trips of 24 hours or more that you have taken outside of the United States since becoming a Lawful
Permanent Resident. Begin with your most recent trip. If you need more space, use a separate sheet(s) of paper.
Date You Left the
United States
(mm/dd/yyyy)
Date You Returned to
the United States
(mm/dd/yyyy)
Did Trip Last
Six Months or
More?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Countries to Which You Traveled
Total Days
Out of the
United States
Part 8. Information About Your Marital History.
A. How many times have you been married (including annulled marriages)?
If you have never been married, go to Part 9.
B. If you are now married, give the following information about your spouse:
1. Spouse's Family Name (Last Name)
Given Name (First Name)
Full Middle Name (If applicable)
2. Date of Birth (mm/dd/yyyy)
3. Date of Marriage (mm/dd/yyyy)
4. Spouse's U.S. Social Security #
Apartment Number
5. Home Address - Street Number and Name
City
State
Zip Code
Form N-400 (Rev. 10/26/05) Page 4
Write your USCIS ''A"- number here:
A
Part 8. Information About Your Marital History. (Continued)
C. Is your spouse a U.S. citizen?
Yes
No
D. If your spouse is a U.S. citizen, give the following information:
At Birth
1. When did your spouse become a U.S. citizen?
Other
If ''Other,'' give the following information:
2. Date your spouse became a U.S. citizen
3. Place your spouse became a U.S. citizen (Please see Instructions)
City and State
E. If your spouse is not a U.S. citizen, give the following information :
2. Spouse's USCIS ''A''- Number (If applicable)
1. Spouse's Country of Citizenship
A
3. Spouse's Immigration Status
Lawful Permanent Resident
Other
F. If you were married before, provide the following information about your prior spouse. If you have more than one previous
marriage, use a separate sheet(s) of paper to provide the information requested in Questions 1-5 below.
1. Prior Spouse's Family Name (Last Name)
Given Name (First Name)
2. Prior Spouse's Immigration Status
3. Date of Marriage (mm/dd/yyyy)
Full Middle Name (If applicable)
4. Date Marriage Ended (mm/dd/yyyy)
U.S. Citizen
Lawful Permanent Resident
Other
5. How Marriage Ended
Divorce
Spouse Died
Other
G. How many times has your current spouse been married (including annulled marriages)?
If your spouse has ever been married before, give the following information about your spouse's prior marriage.
If your spouse has more than one previous marriage, use a separate sheet(s) of paper to provide the information requested in
Questions 1 - 5 below.
1. Prior Spouse's Family Name (Last Name)
Given Name (First Name)
2. Prior Spouse's Immigration Status
3. Date of Marriage (mm/dd/yyyy)
Full Middle Name (If applicable)
4. Date Marriage Ended (mm/dd/yyyy)
U.S. Citizen
Lawful Permanent Resident
Other
5. How Marriage Ended
Divorce
Spouse Died
Other
Form N-400 (Rev. 10/26/05)Y Page 5
Part 9. Information About Your Children.
Write your USCIS ''A"- number here:
A
A. How many sons and daughters have you had? For more information on which sons and
daughters you should include and how to complete this section, see the Instructions.
B. Provide the following information about all of your sons and daughters. If you need more space, use a separate sheet(s) of paper.
Full Name of
Son or Daughter
Date of Birth
(mm/dd/yyyy)
USCIS ''A''- number
(if child has one)
Country of Birth
Current Address
(Street, City, State and Country)
A
A
A
A
A
A
A
A
Add Children
Go to continuation page
Part 10. Additional Questions.
Please answer Questions 1 through 14. If you answer ''Yes'' to any of these questions, include a written explanation with this form. Your
written explanation should (1) explain why your answer was ''Yes'' and (2) provide any additional information that helps to explain your
answer.
A. General Questions.
1. Have you ever claimed to be a U.S. citizen (in writing or any other way)?
Yes
No
2. Have you ever registered to vote in any Federal, state or local election in the United States?
Yes
No
3. Have you ever voted in any Federal, state or local election in the United States?
Yes
No
4. Since becoming a Lawful Permanent Resident, have you ever failed to file a required Federal
state or local tax return?
Yes
No
5. Do you owe any Federal, state or local taxes that are overdue?
Yes
No
6. Do you have any title of nobility in any foreign country?
Yes
No
7. Have you ever been declared legally incompetent or been confined to a mental institution
within the last five years?
Yes
No
Form N-400 (Rev. 10/26/05)Y Page 6
Write your USCIS ''A"- number here:
A
Part 10. Additional Questions. (Continued)
B. Affiliations.
8. a Have you ever been a member of or associated with any organization, association, fund
foundation, party, club, society or similar group in the United States or in any other place?
Yes
No
b. If you answered ''Yes,'' list the name of each group below. If you need more space, attach the names of the other group(s) on a
separate sheet(s) of paper.
Name of Group
Name of Group
1.
6.
2.
7.
3.
8.
4.
9.
5.
10.
9. Have you ever been a member of or in any way associated (either directly or indirectly) with:
a. The Communist Party?
Yes
No
b. Any other totalitarian party?
Yes
No
c. A terrorist organization?
Yes
No
10. Have you ever advocated (either directly or indirectly) the overthrow of any government
by force or violence?
Yes
No
11. Have you ever persecuted (either directly or indirectly) any person because of race,
religion, national origin, membership in a particular social group or political opinion?
Yes
No
a. The Nazi government of Germany?
Yes
No
b. Any government in any area (1) occupied by, (2) allied with, or (3) established with the
help of the Nazi government of Germany?
Yes
No
c. Any German, Nazi, or S.S. military unit, paramilitary unit, self-defense unit, vigilante unit,
citizen unit, police unit, government agency or office, extermination camp, concentration
camp, prisoner of war camp, prison, labor camp or transit camp?
Yes
No
13. Have you ever called yourself a ''nonresident'' on a Federal, state or local tax return?
Yes
No
14. Have you ever failed to file a Federal, state or local tax return because you considered
yourself to be a "nonresident"?
Yes
No
12. Between March 23, 1933 and May 8, 1945, did you work for or associate in any way (either
directly or indirectly) with:
C. Continuous Residence.
Since becoming a Lawful Permanent Resident of the United States:
Form N-400 (Rev.10/26/05) Y Page 7
Write your USCIS ''A"- number here:
A
Part 10. Additional Questions. (Continued)
D. Good Moral Character.
For the purposes of this application, you must answer ''Yes'' to the following questions, if applicable, even if your records were
sealed or otherwise cleared or if anyone, including a judge, law enforcement officer or attorney, told you that you no longer have a
record.
15. Have you ever committed a crime or offense for which you were not arrested?
Yes
No
16. Have you ever been arrested, cited or detained by any law enforcement officer
(including USCIS or former INS and military officers) for any reason?
Yes
No
17. Have you ever been charged with committing any crime or offense?
Yes
No
18. Have you ever been convicted of a crime or offense?
Yes
No
19. Have you ever been placed in an alternative sentencing or a rehabilitative program
(for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)?
Yes
No
20. Have you ever received a suspended sentence, been placed on probation or been paroled?
Yes
No
21. Have you ever been in jail or prison?
Yes
No
If you answered "Yes" to any of Questions 15 through 21, complete the following table. If you need more space, use a separate sheet
(s) of paper to give the same information.
Why were you arrested, cited,
detained or charged?
Date arrested, cited,
detained or charged?
(mm/dd/yyyy)
Where were you arrested,
cited, detained or charged?
(City, State, Country)
Outcome or disposition of the
arrest, citation, detention or charge
(No charges filed, charges
dismissed, jail, probation, etc.)
Answer Questions 22 through 33. If you answer "Yes" to any of these questions, attach (1) your written explanation why your answer
was ''Yes'' and (2) any additional information or documentation that helps explain your answer.
22. Have you ever:
a. Been a habitual drunkard?
Yes
No
b. Been a prostitute, or procured anyone for prostitution?
Yes
No
c. Sold or smuggled controlled substances, illegal drugs or narcotics?
Yes
No
d. Been married to more than one person at the same time?
Yes
No
e. Helped anyone enter or try to enter the United States illegally?
Yes
No
f. Gambled illegally or received income from illegal gambling?
Yes
No
g. Failed to support your dependents or to pay alimony?
Yes
No
23. Have you ever given false or misleading information to any U.S. government official
while applying for any immigration benefit or to prevent deportation, exclusion or removal?
Yes
No
24. Have you ever lied to any U.S. government official to gain entry or admission into the
United States?
Yes
No
Form N-400 (Rev. 10/26/05)Y Page 8
Write your USCIS ''A"- number here:
A
Part 10. Additional Questions. (Continued)
E. Removal, Exclusion and Deportation Proceedings.
25. Are removal, exclusion, rescission or deportation proceedings pending against you?
Yes
No
26. Have you ever been removed, excluded or deported from the United States?
Yes
No
27. Have you ever been ordered to be removed, excluded or deported from the United States?
Yes
No
28. Have you ever applied for any kind of relief from removal, exclusion or deportation?
Yes
No
29. Have you ever served in the U.S. Armed Forces?
Yes
No
30. Have you ever left the United States to avoid being drafted into the U.S. Armed Forces?
Yes
No
31. Have you ever applied for any kind of exemption from military service in the U.S. Armed Forces?
Yes
No
32. Have you ever deserted from the U.S. Armed Forces?
Yes
No
Yes
No
F. Military Service.
G. Selective Service Registration.
33. Are you a male who lived in the United States at any time between your 18th and 26th birthdays
in any status except as a lawful nonimmigrant?
If you answered "NO," go on to question 34.
If you answered "YES," provide the information below.
If you answered "YES," but you did not register with the Selective Service System and are still under 26 years of age, you
must register before you apply for naturalization, so that you can complete the information below:
Date Registered (mm/dd/yyyy)
Selective Service Number
If you answered "YES," but you did not register with the Selective Service and you are now 26 years old or older, attach a
statement explaining why you did not register.
H. Oath Requirements. (See Part 14 for the Text of the Oath)
Answer Questions 34 through 39. If you answer ''No'' to any of these questions, attach (1) your written explanation why the
answer was ''No'' and (2) any additional information or documentation that helps to explain your answer.
34. Do you support the Constitution and form of government of the United States?
Yes
No
35. Do you understand the full Oath of Allegiance to the United States?
Yes
No
36. Are you willing to take the full Oath of Allegiance to the United States?
Yes
No
37. If the law requires it, are you willing to bear arms on behalf of the United States?
Yes
No
38. If the law requires it, are you willing to perform noncombatant services in the U.S. Armed Forces?
Yes
No
39. If the law requires it, are you willing to perform work of national importance under civilian
direction?
Yes
No
Form N-400 (Rev. 10/26/05)Y Page 9
Part 11. Your Signature.
Write your USCIS ''A"- number here:
A
I certify, under penalty of perjury under the laws of the United States of America, that this application, and the evidence submitted with it,
are all true and correct. I authorize the release of any information that the USCIS needs to determine my eligibility for naturalization.
Date (mm/dd/yyyy)
Your Signature
Part 12. Signature of Person Who Prepared This Application for You. (If Applicable)
I declare under penalty of perjury that I prepared this application at the request of the above person. The answers provided are based on
information of which I have personal knowledge and/or were provided to me by the above named person in response to the exact questions
contained on this form.
Preparer's Printed Name
Date (mm/dd/yyyy)
Preparer's Signature
Preparer's Firm or Organization Name (If applicable)
Preparer's Address - Street Number and Name
City
Preparer's Daytime Phone Number
State
Zip Code
NOTE: Do not complete Parts 13 and 14 until a USCIS Officer instructs you to do so.
Part 13. Signature at Interview.
I swear (affirm) and certify under penalty of perjury under the laws of the United States of America that I know that the contents of this
application for naturalization subscribed by me, including corrections numbered 1 through
and the evidence submitted by me
numbered pages 1 through
, are true and correct to the best of my knowledge and belief.
Subscribed to and sworn to (affirmed) before me
Date (mm/dd/yyyy)
Officer's Printed Name or Stamp
Complete Signature of Applicant
Officer's Signature
Part 14. Oath of Allegiance.
If your application is approved, you will be scheduled for a public oath ceremony at which time you will be required to take the following
oath of allegiance immediately prior to becoming a naturalized citizen. By signing, you acknowledge your willingness and ability to take
this oath:
I hereby declare, on oath, that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince, potentate,
state, or sovereignty, of whom or which I have heretofore been a subject or citizen;
that I will support and defend the Constitution and laws of the United States of America against all enemies, foreign and domestic;
that I will bear true faith and allegiance to the same;
that I will bear arms on behalf of the United States when required by the law;
that I will perform noncombatant service in the Armed Forces of the United States when required by the law;
that I will perform work of national importance under civilian direction when required by the law; and
that I take this obligation freely, without any mental reservation or purpose of evasion; so help me God.
Printed Name of Applicant
Complete Signature of Applicant
Form N-400 (Rev. 10/26/05)Y Page 10
| File Type | application/pdf |
| File Modified | 2006-03-01 |
| File Created | 2006-02-21 |