N-644 Application for Posthumous Citizenship

OMB No. 1615-0059; Expires 06/30/07

N-644, Application for
Posthumous Citizenship

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

For USCIS Only
Fee Stamp

Part 1.

Information about the Applicant. (To be completed by the Applicant only.)

1. Name (Last/First/Middle)

6. Your Relationship to Decedent at time of his/her death (Check one.)

Next-of-Kin
2. Address (Street Name and Number)

(Town/City, State/Country, Zip/Postal Code)

3. If abroad, City/Country of nearest American Embassy or Consulate

4. Telephone Number (Include Area/Country Code)

(

)

5. Total Number of Authorization Affidavits Attached (See instructions.)

a.

Spouse

b.

Parent

c.

Son/Daughter

d.

Brother/Sister

Representative
e.

Executor or Administrator of Decedent's Estate

f.

Guardian, Conservator or Committee of Decedent's Next-of-Kin

g.

VA Recognized Service Organization (Name below.)
(Name of Service Organization)

B. Information about the Decedent.
1. Name Used During Active Service (Last/First/Middle)

2. Other Names Used

3. Date of Birth (mm/dd/yyyy)

10. Father's Full Name

11. Mother's Maiden Name
4. Place of Birth (City/State/Country)
12. Marital Status at Time of Death

5. Date of Death (mm/dd/yyyy)

6. Place of Death (City/State/Country)

7. Immigration Status at Time of Death (Permanent Resident, Student,
Visitor, etc.)

8. Alien Registration Number or Other USCIS File Number

9. U.S. Social Security Number (If any.)

a.

Living

b.

Deceased

a.

Living

b.

Deceased

a.

Married

b.

Widowed

c.

Divorced

d.

Single

13. Military Service Serial Number (If different from Social Security #.)

14. Date of Entered Active Duty Service (mm/dd/yyyy)

15. Place Entered Active Duty Service (City/State/Country)

Form N-644 (Rev. 07/30/07) Y

16. Date Released From Active Duty Service (mm/dd/yyyy)

24. Total Number of Brothers and Sisters (If none, write None.)

17. Branch of Service

25. Complete the following for each Brother and Sister.

18. Type of Discharge

Name (Last/First/Middle)
19. Military Rank at Time of Discharge

Date of Birth (mm/dd/yyyy)

20. Retired From Military?
Yes

No

a.

Living

b.

Deceased

a.

Living

b.

Deceased

a.

Living

b.

Deceased

21. VA Claim Number (If any.)

22. Total Number of Children (If none, write None.)

Certificate of Applicant.

23. Complete the following for each Child.
Name (Last/First/Middle)

I certify, under penalty of perjury under the laws of the United States
of America, that the information in Part I is true and correct.

Date of Birth (mm/dd/yyyy)
a.

Living

b.

Deceased

a.

Living

b.

Deceased

a.

Living

b.

Deceased

Signature

Date

Name (Print or Type)
Address (Street Number and Name, City/Town, State/Province, Country, ZipPostal Code

Part II. To be completed by the applicable Executive Department.
1.

No Active Duty Records Found for This Individual

2.

No Casualty Records Found for This Individual

3.

Name of Decedent Correctly Shown

4.

Name of Decedent Different in Records

d. Service Number

e. Date Released From Service (mm/dd/yyyy)

f. Honorable Service During a Period of Hostilities

(List name shown in records)

5.

Active Duty Service Records Found
(Complete a through f)

by

b. Date Entered Active Duty

c. Place Entered Active Duty Service (City/State/Country)

No

6. Individual Entered Service Under the Lodge Act?
No

Yes
7.

a. Branch of Service

Yes

Unable to Determine

Record of Death Found
(Complete a and b
a. Date of Death (mm/dd/yyyy)

b. Death resulted from injury or disease incurred in or aggravated
by active duty service during a period of military hostilities
specified by law?
Yes

No

Unable to Determine

Form N-644 (Rev. 07/30/07) Y Page 2

8.

Certification.

Signature

Date

I certify the information given here concerning the
(Check one or both, as appropriate.)
Service

Title
Death

of the individual named on this form is correct according to the
records of the (Name below)
(Specify Executive Department)

Part III. To be completed by the Department of Defense, Washington Headquarters Services,
Directorate for Information Operations and Reports.
B. Unable to Certify.

A. Certification.

Based on the information received from the Department
of Veterans Affairs concerning the death of the
individual named on this form, I am unable to certify that
the individual died as a result of injury or disease
incurred in or aggravated by service during a period of
hostilities specified by law.

Based on the information received from the Department
of Veterans Affairs concerning the death of the
individual named on this form, I certify that the
individual died on:

Signature

Date (mm/dd/yyyy)
as a result of injury or disease incurred in or aggravated
by service during a period of hostilities specified by law.
Signature

Date

Title

Date

Title

NOTE: Space below (Part IV) for use by U.S. Citizenship and Immigration Services (Only.)
Part IV. To be completed by U.S. Citizenship and Immigration Services.
Applicant Authorized Next-of-Kin or Representative

Action Block

Positive Certification Military Service
Positive Certification Service Connected Death
Place of Enlistment Qualifies Under INA Section 329 (a)(1)
Decedent Admitted for Lawful Permanent Residence

Cert. #

Date Mailed

A#

Reg. Mail #

Initial Receipt

Resubmitted

Relocated
Rec'd

Completed

Sent

App'd Denied

Ret'd

Form N-644 (Rev. 07/30/07) Y Page 3