Form N-426 Request for Certification of Military or Naval Service

OMB No. 1615-0053; Expires 06/30/07

N-426, Request for Certification
of Military or Naval Service

Department of Homeland Security
U.S. Citizenship and Immigration Services

Instructions
(Please discard this sheet before submitting request. Submit in triplicate, that is, all six pages of the form.)

NOTE: Please type or print in block letters with a ball-point pen, using black ink. Be sure this form and the complete
return address are legible. Do not leave any questions unanswered. When appropriate insert "none," "not applicable" or
"N/A."

What Is the Purpose of This Form?
The principal purpose of this form is to solicit
information to secure a duly authenticated certification of
honorable active duty service from the U.S. Government
Executive Department, under which you served or are
serving, to satisfy statutory requirements for
naturalization as a U.S. citizen.
Submission of the information is voluntary. If your U.S.
Social Security number requested on the form is not
provided, no right, benefit or privilege will be denied for
such failure. However, as military records are indexed
by such numbers, verification of your military service
may prove difficult.
If you are applying for naturalization under Sections 328
or 329 of the Immigration and Nationality Act, you
should submit this form and Form G-325B, Biographic
Information, with your Form N-400, Application for
Naturalization, to U.S. Citizenship and Immigration
Services (USCIS).

What Is Our Authority for
Collecting This Information?
Our authority for collecting the information requested on
this form is contained in Sections 328 and 329 of the
Immigration and Nationality Act of 1952 (8 U.S.C. 1439
and 1440).
All or part of the information solicited may as a matter
of routine use be disclosed to courts exercising
naturalization jurisdiction and to other Federal, state,
local and foreign law enforcement and regulatory
agencies, the Department of Defense, including any
component thereof, Selective Service System,
Department of State, Department of the Treasury,
Central Intelligence Agency, Interpol and individuals
and organizations that process the application for
naturalization, or during the courses of investigation, to
elicit further information required by USCIS to carry
out its functions.

Information solicited that indicates a violation or
potential violation of law, whether civil, criminal or
regulatory in nature, may be referred as a routine use to
the appropriate agency, whether Federal, state, local or
foreign, charged with the responsibility of investigating,
enforcing or prosecuting such violations.
Failure to provide any or all of the solicited information
may delay the naturalization process or result in a failure
to locate military records or prove qualifying military
service.

Paperwork Reduction Act Notice.
An agency may not conduct or sponsor an information
collection and a person is not required to respond to a
collection of information unless it displays a currently
valid OMB control number.
This collection of information is estimated to average 45
minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and
reviewing the collection of information.
Send comments regarding this burden estimate or any
other aspect of this collection of information, including
suggestions for reducing this burden to U.S. Citizenship
and Immigration Services, Regulatory Management
Division, 111 Massachusetts Avenue, N.W., 3rd Floor,
Suite 3008 Washington, D.C. 20529. Do not mail your
completed application to this address.

Form N-426 Instructions (Rev. 06/30/06)Y

OMB No. 1615-0053; Expires 06/30/07

N-426, Request for Certification
of Military or Naval Service

Department of Homeland Security
U.S. Citizenship and Immigration Services

Date of Request

Alien Registration Number

NOTE TO CERTIFYING OFFICER: For use in connection with my application for naturalization, please complete the certification of military
service on Pages 2, 4, and 6 of this form and furnish it to the office of U.S. Citizenship and Immigration Services (USCIS) shown in the address
block below. The information shown below is furnished to help locate and identify my military records. (Submit in triplicate, that is, all six
pages of this form.)
NOTE TO APPLICANT: Furnish as much information as possible. If you were issued a Report of Separation, DD Form 214, attach a
copy. Fill in the blanks only on Pages 1, 3 and 5 of this form. Please type or print clearly in black ink. All copies must be legible. Do not
use pencil. (Submit in triplicate, that is, all six pages of this form.)
Place of Birth
Name Used During Active Service (Last, First, Middle) U.S. Social Security Number Date of Birth
For an effective records search, it is important that ALL periods of service be shown below. (Use blank sheet(s) if more space is needed.)
Active Service:
Branch of Service
(Show also last organization, if known.)

Reserve or National Guard Service:
Branch of Service



Check Which
Reserve N. Guard

Are you a Military Retiree or Fleet Reservist?
Signature (Present Name)

Date Entered
on Active Duty

If none, check

Date Released
From Active Duty

Service Number
During This Period

Check Which
Officer
Enlisted

Service Number
During This Period

None

Date Membership
Began

No

Check Which
Officer
Enlisted

Date Membership
Ended

Yes

Present Address (Number, Street, City, State and Zip Code)

Instructions to Certifying Officer.
Persons who are serving or have served honorably under specified conditions in the armed forces of the United States, inclusive of the reserve
components of the armed forces of the United States, are granted certain exemptions from the general requirements for naturalization. The law
requires such service to be established by a duly authenticated copy of the records of the executive department having custody of the record of
service, showing whether the service man or woman served honorably in an active-duty status, reserve-duty status, or both, and whether each
separation from the service was under honorable conditions. For that purpose, the certified statement on Pages 2, 4 and 6 of this form, executed
under the seal of your department, is required and should cover not only the period(s) of service shown above, but any other periods of service
(active, reserve or both) rendered by the service man or woman.
Pages 2, 4 and 6 of this form should be completed, or the information called for furnished by separate letter, and the form and letter returned to the
office of U. S. Citizenship and Immigration Services at the address in the block immediately below.
U.S. Citizenship and Immigration Services

Return to:
Please type
or print
complete
return
address.
Include zip
code.
Form N-426 (Rev. 06/30/06)Y Page 1

Applicant: Do not fill out this page.
Certification of Military or Naval Service.
Name correctly shown on front of form.
Name as shown in records:
Active Service.
1. Entered Service at

2. On

3. Served to

4. Branch of
Service

5. State whether serving honorably. If separated, state
whether under honorable conditions. If other than
honorable, give full details. Always complete item
11.

Reserve or National Guard Service.
6. Branch of Service

7. Check Which
Reserve

8. Began

9. Ended

10. State whether serving honorably. State if Selected Reserve
of the Ready Reserve. If separated, state whether under
honorable conditions. If other than honorable, give full
details. Always complete Item 11.

N. Guard

11. Statement Regarding Alienage. (Complete this item in ALL cases.)
Record shows this person was not discharged on account of alienage.
Record shows this person was discharged on account of alienage. Details:
12. Remarks. Use for continuation of any of the above items. You should also show in the space below any derogatory information in your
records relating to the person's character, loyalty to the United States, disciplinary actions, convictions or other matters concerning his or her
fitness for citizenship.

Lodge Act Enlistee.
Complete this block if subject is a "Lodge Act Enlistee"-64 Stat. 316 (Army). Subsequent to enlistment under the Lodge Act on
subject entered

at the port of
(the United States, American Samoa, Swains Island or the Panama Canal Zone)

pursuant to Military orders on

via

I CERTIFY that the information here given concerning the service of the person named on the face of this form is correct according to the records
of the
(Name of department or organization)

(Official Signature)

[ SEAL ]
Date

,

By
Form N-426 (Rev. 06/30/06)Y Page 2

OMB No. 1615-0053; Expires 06/30/07

N-426, Request for Certification
of Military or Naval Service

Department of Homeland Security
U.S. Citizenship and Immigration Services

Date of Request

Alien Registration Number

NOTE TO CERTIFYING OFFICER: For use in connection with my application for naturalization, please complete the certification of military
service on Pages 2, 4, and 6 of this form and furnish it to the office of U.S. Citizenship and Immigration Services (USCIS) shown in the address
block below. The information shown below is furnished to help locate and identify my military records. (Submit in triplicate, that is, all six
pages of this form.)
NOTE TO APPLICANT: Furnish as much information as possible. If you were issued a Report of Separation, DD Form 214, attach a
copy. Fill in the blanks only on Pages 1, 3 and 5 of this form. Please type or print clearly in black ink. All copies must be legible. Do not
use pencil. (Submit in triplicate, that is, all six pages of this form.)
Place of Birth
Name Used During Active Service (Last, First, Middle) U.S. Social Security Number Date of Birth

For an effective records search, it is important that ALL periods of service be shown below. (Use blank sheet(s) if more space is needed.)
Active Service:
Check Which
Service Number
Branch of Service
Date Entered
Date Released
During This Period
(Show also last organization, if known.)
on Active Duty
Officer
Enlisted
From Active Duty

Reserve or National Guard Service:
Branch of Service



Check Which
Reserve N. Guard

Are you a Military Retiree or Fleet Reservist?
Signature (Present Name)

If none, check

None

Date Membership
Began

No

Date Membership
Ended

Check Which
Officer
Enlisted

Service Number
During This Period

Yes

Present Address (Number, Street, City, State and Zip Code)

Instructions to Certifying Officer.
Persons who are serving or have served honorably under specified conditions in the armed forces of the United States, inclusive of the reserve
components of the armed forces of the United States, are granted certain exemptions from the general requirements for naturalization. The law
requires such service to be established by a duly authenticated copy of the records of the executive department having custody of the record of
service, showing whether the service man or woman served honorably in an active-duty status, reserve-duty status, or both, and whether each
separation from the service was under honorable conditions. For that purpose, the certified statement on Pages 2, 4 and 6 of this form, executed
under the seal of your department, is required and should cover not only the period(s) of service shown above, but any other periods of service
(active, reserve or both) rendered by the service man or woman.
Pages 2, 4 and 6 of this form should be completed, or the information called for furnished by separate letter, and the form and letter returned to the
office of U. S. Citizenship and Immigration Services at the address in the block immediately below.
U.S. Citizenship and Immigration Services

Return to:
Please type
or print
complete
return
address.
Include zip
code.
Form N-426 (Rev. 06/30/06)Y Page 3

Applicant: Do not fill out this page.
Certification of Military or Naval Service.
Name correctly shown on front of form.
Name as shown in records:
Active Service.
1. Entered Service at

2. On

3. Served to

4. Branch of
Service

5. State whether serving honorably. If separated, state
whether under honorable conditions. If other than
honorable, give full details. Always complete item
11.

Reserve or National Guard Service.
6. Branch of Service

7. Check Which
Reserve

8. Began

9. Ended

10. State whether serving honorably. State if Selected Reserve
of the Ready Reserve. If separated, state whether under
honorable conditions. If other than honorable, give full
details. Always complete Item 11.

N. Guard

11. Statement Regarding Alienage. (Complete this item in ALL cases.)
Record shows this person was not discharged on account of alienage.
Record shows this person was discharged on account of alienage. Details:
12. Remarks. Use for continuation of any of the above items. You should also show in the space below any derogatory information in your
records relating to the person's character, loyalty to the United States, disciplinary actions, convictions or other matters concerning his or her
fitness for citizenship.

Lodge Act Enlistee.
Complete this block if subject is a "Lodge Act Enlistee"-64 Stat. 316 (Army). Subsequent to enlistment under the Lodge Act on
subject entered

at the port of
(the United States, American Samoa, Swains Island or the Panama Canal Zone)

pursuant to Military orders on

via

I CERTIFY that the information here given concerning the service of the person named on the face of this form is correct according to the records
of the
(Name of department or organization)

(Official Signature)

[ SEAL ]
Date

,

By
Form N-426 (Rev. 06/30/06)Y Page 4

OMB No. 1615-0053; Expires 06/30/07

N-426, Request for Certification
of Military or Naval Service

Department of Homeland Security
U.S. Citizenship and Immigration Services

Date of Request

Alien Registration Nu mber

NOTE TO CERTIFYING OFFICER: For use in connection with my application for naturalization, please complete the certification of military
service on Pages 2, 4, and 6 of this form and furnish it to the office of U.S. Citizenship and Immigration Services (USCIS) shown in the address
block below. The information shown below is furnished to help locate and identify my military records. (Submit in triplicate, that is, all six pages
of this form.)
NOTE TO APPLICANT: Furnish as much information as possible. If you were issued a Report of Separation, DD Form 214, attach a
copy. Fill in the blanks only on Pages 1, 3 and 5 of this form. Please type or print clearly in black ink. All copies must be legible. Do not
use pencil. (Submit in triplicate, that is, all six pages of this form.)
Place of Birth
Name Used During Active Service (Last, First, Middle) U.S. Social Security Number Date of Birth

For an effective records search, it is important that ALL periods of service be shown below. (Use blank sheet(s) if more space is needed.)
Active Service:
Branch of Service
(Show also last organization, if known.)

Reserve or National Guard Service:
Branch of Service



Check Which
Reserve N. Guard

Are you a Military Retiree or Fleet Reservist?
Signature (Present Name)

Date Entered
on Active Duty

If none, check

Date Released
From Active Duty

Service Number
During This Period

Check Which
Officer
Enlisted

Service Number
During This Period

None

Date Membership
Began

No

Check Which
Officer
Enlisted

Date Membership
Ended

Yes

Present Address (Number, Street, City, State and Zip Code)

Instructions to Certifying Officer.
Persons who are serving or have served honorably under specified conditions in the armed forces of the United States, inclusive of the reserve
components of the armed forces of the United States, are granted certain exemptions from the general requirements for naturalization. The law
requires such service to be established by a duly authenticated copy of the records of the executive department having custody of the record of
service, showing whether the service man or woman served honorably in an active-duty status, reserve-duty status, or both, and whether each
separation from the service was under honorable conditions. For that purpose, the certified statement on Pages 2, 4, and 6 of this form, executed
under the seal of your department, is required and should cover not only the period(s) of service shown above, but any other periods of service
(active, reserve or both) rendered by the service man or woman.
Pages 2 ,4 and 6 of this form should be completed, or the information called for furnished by separate letter, and the form and letter returned to the
office of U. S. Citizenship and Immigration Services at the address in the block immediately below.
U.S. Citizenship and Immigration Services

Return to:
Please type
or print
complete
return
address.
Include zip
code.
Form N-426 (Rev. 06/30/06)Y Page 5

Applicant: Do not fill out this page.
Certification of Military or Naval Service.
Name correctly shown on front of form.
Name as shown in records:
Active Service.
1. Entered Service at

2. On

3. Served to

4. Branch of
Service

5. State whether serving honorably. If separated, state
whether under honorable conditions. If other than
honorable, give full details. Always complete item
11.

Reserve or National Guard Service.
6. Branch of Service

7. Check Which
Reserve

8. Began

9. Ended

10. State whether serving honorably. State if Selected Reserve
of the Ready Reserve. If separated, state whether under
honorable conditions. If other than honorable, give full
details. Always complete Item 11.

N. Guard

11. Statement Regarding Alienage. (Complete this item in ALL cases.)
Record shows this person was not discharged on account of alienage.
Record shows this person was discharged on account of alienage. Details:
12. Remarks. Use for continuation of any of the above items. You should also show in the space below any derogatory information in your
records relating to the person's character, loyalty to the United States, disciplinary actions, convictions or other matters concerning his or her
fitness for citizenship.

Lodge Act Enlistee.
Complete this block if subject is a "Lodge Act Enlistee"-64 Stat. 316 (Army). Subsequent to enlistment under the Lodge Act on
subject entered

at the port of
(the United States, American Samoa, Swains Island or the Panama Canal Zone)

pursuant to Military orders on

via

I CERTIFY that the information here given concerning the service of the person named on the face of this form is correct according to the records
of the
(Name of department or organization)

(Official Signature)

[ SEAL ]
Date

,

By
Form N-426 (Rev. 06/30/06)Y Page 6