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

OMB No. 1615-0053; Expires 08/31/08

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.)
Date of Birth
Place of Birth
Name Used During Active Service (Last, First, Middle) U.S. Social Security Number
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 also any other periods of service (active, reserve, or both) rendered by the service
man or woman.
U.S. Citizenship and Immigration Services

Return to:
Please type
or print
complete
return
address.
Include zip
code.
Form N-426 (Rev. 05/21/08)Y

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
(City and State)

2. On

4. Branch of
Service

3. Served to

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
7. Check Which

6. Branch of Service

Reserve

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

9. Ended

8. Began

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)

[ SEAL, if available ]

(Official Signature)

(No State-issued notary public
seals accepted.)

Date

,

By

(Title)
Telephone number
Form N-426 (Rev. 05/21/08)Y Page 2

OMB No. 1615-0053; Expires 08/31/08

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 also any other periods of service (active, reserve, or both) rendered by the service
man or woman.
U.S. Citizenship and Immigration Services

Return to:
Please type
or print
complete
return
address.
Include zip
code.
Form N-426 (Rev. 05/21/08)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
(City and State)

2. On

4. Branch of
Service

3. Served to

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
7. Check Which

6. Branch of Service

Reserve

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

9. Ended

8. Began

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)

[ SEAL, if available ]

(Official Signature)

(No State-issued notary public
seals accepted.)

Date

,

By

(Title)
Telephone number
Form N-426 (Rev. 05/21/08)Y Page 4

OMB No. 1615-0053; Expires 08/31/08

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 also any other periods of service (active, reserve, or both) rendered by the service
man or woman.
U.S. Citizenship and Immigration Services

Return to:
Please type
or print
complete
return
address.
Include zip
code.
Form N-426 (Rev. 05/21/08)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
(City and State)

2. On

7. Check Which

6. Branch of Service

Reserve

4. Branch of
Service

3. Served to

N. Guard

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

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)

[ SEAL, if available ]

(Official Signature)

(No State-issued notary public
seals accepted.)

Date

,

By

(Title)
Telephone number
Form N-426 (Rev. 05/21/08)Y Page 6