Form N-600K Form N-600K Application for Citizenship and Issuance of Certificate

OMB No. 1615-0087; Expires 09/30/09

N-600K, Application for Citizenship and
Issuance of Certificate Under Section 322

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

Print clearly or type your answers in black ink, using CAPITAL letters. Failure to print clearly may delay your application.

Part 1. Information about your child. (Provide information about the child on
whose behalf this application for citizenship and a Certificate of
Citizenship is being filed.)

If your child has an "A" Number,
write it here:

-

A. Current legal name.

-

Family Name (Last Name)

For USCIS Use Only
Given Name (First Name)

Full Middle Name (If applicable)
Date Stamp

Bar Code

B. Name exactly as it appears on your Permanent Resident Card (If applicable).
Family Name (Last Name)

Given Name (First Name)

Full Middle Name (If applicable)
Remarks

C. Other names used since birth.
Family Name (Last Name)

Given Name (First Name)

Middle Name (If Applicable)

Action

D. U.S. Social Security # (If Applicable)

E.

F. Country of Birth

G. Country of Citizenship/Nationality

H. Gender

I.

Male

Date of Birth (mm/dd/yyyy)

Height

Female

Part 2. Information About the Child's Eligibility. (Check only one.)
This application is being filed on my behalf based on the fact that:
A.

I am a BIOLOGICAL child (under 18 years) of a United States citizen parent who is applying for citizenship on my behalf.

B.

I am an ADOPTED child (under 18 years) of a United States citizen parent who is applying for citizenship on my behalf.

C.

I am a child (under 18 years) of a United States citizen parent who died during the five years preceding the filing of this
application. A United States citizen grandparent or a United States citizen legal guardian is applying for citizenship on my
behalf.

Part 3. Additional Information About the Child. (Provide information about the child on whose behalf this
application for citizenship and a Certificate of Citizenship is being filed.)
A.

Apartment Number

Home Address - Street Number and Name (Do not write a P.O. Box in this space.)

City

State or Province

County

Country

Zip Code

Form N-600K (Rev. 09/06/07)Y

Part 3. Additional information about the child. (Provide information about the child on whose behalf this
application for citizenship and a Certificate of Citizenship is being filed.) - Continued.
B.

Mailing Address - Street Number and Name (If Different From Home Address)

City

County

C.

Daytime Phone Number (If any)

D.

Marital Status

Apartment Number

State or Province

Country

Evening Phone Number (If any)

Single, Never Married

Married

Zip Code

E-Mail Address (If any)

Divorced

Widowed

Marriage Annulled or Other (Explain)
E.

Information about entry into the United States and current immigration status.
(Do not complete this section. The Adjudicator will complete it with you during the interview.)
I arrived in the following manner:
Port of Entry (City/State)

Date of Entry (mm/dd/yyyy)

Current Immigration Status

Exact Name Used at Time of Entry:

F.

Do you know of any prior application for a certificate of citizenship or U.S. passport for this child?

G.

Was the child adopted?

No

Date of Adoption (mm/dd/yyyy)

H.

No

Yes

Yes (Please complete the following information.)
Date Legal Custody Began (mm/dd/yyyy)

Date Physical Custody Began (mm/dd/yyyy)

Were the child's parents married to each other when the child was born (or adopted)?

No

Yes

Part 4. Information about the child's U.S. citizen father or mother (or adoptive father or mother). (If you
are a United States citizen father or mother applying for citizenship and a Certificate of Citizenship on behalf
of your eligible child, provide information about yourself below). If you are a U.S. citizen grandparent or
legal guardian, provide information about the child's U.S. citizen parent in the sections noted.
A.

Current legal name of U.S. citizen father or mother.
Family Name (Last Name)

Given Name (First Name)

B.

Date of Birth (mm/dd/yyyy)

C.

D.

Home Address - Street Number and Name

City

County

Full Middle Name (If applicable)

Country of Birth

Apartment Number

State or Province

Country

Zip Code

Form N-600K (Rev. 09/06/07)Y Page 2

Part 4. Information about the child's U.S. citizen father or mother (or adoptive father or mother). (If you
are a United States citizen father or mother applying for citizenship and a Certificate of Citizenship on behalf
of your eligible child, provide information about yourself below). If you are a U.S. citizen grandparent or
legal guardian, provide information about the child's U.S. citizen parent in the sections noted.- (Continued.)
E.

U.S. citizen by:
Birth in the United States
Naturalization
Date of Naturalization (mm/dd/yyyy)

Place of Naturalization
(Name of Court and City/State or USCIS (or former INS) Office Location)

Certificate of Naturalization Number

Former ''A'' Number (If known)

Through birth abroad to U.S. citizen parent(s)
Acquired after birth through naturalization of alien parent(s)
F.

Has the U.S. citizen father or mother ever lost U.S. citizenship or taken any action that would cause loss of United States
citizenship?
Yes (Please provide full explanation.)

No

G. Dates of Residence and/or Physical Presence in the United States.
Provide the dates the U.S. citizen father or mother resided in or was physically present in the United States. If you need more space, use a
separate sheet of paper.
From (Month/Day/Year - mm/dd/yyyy)

To (Month/Day/Year - mm/dd/yyyy)

H. Marital History.
1.

How many times has the U.S. citizen father or mother been married (including annulled marriages)?

2.

Information about the U.S. citizen father or mother's current spouse:
Family Name (Last Name)

Given Name (First Name)

Full Middle Name (If applicable)

Date of Birth (mm/dd/yyyy)

Country of Birth

Country of Citizenship/Nationality

Home Address - Street Number and Name
City

County

Date of Marriage (mm/dd/yyyy)

Apartment Number
State or Province

Country

Zip Code

Place of Marriage (City/State or Country)

Spouse's Immigration Status:
U.S. Citizen

3.

Lawful Permanent Resident

Other (Explain)

Is the U.S. citizen Father or Mother's current spouse listed in Question 2 above also the parent of the
child (biological or adoptive) for whom this application is being submitted?

No

Yes

Form N-600K (Rev. 09/06/07)Y Page 3

Part 5. Information about the U.S. citizen grandfather or grandmother. (Complete this section only if you
are a U.S. citizen parent (or adoptive parent) grandparent or legal guardian applying for a Certificate of
Citizenship for your biological or adopted child and the citizen parent has not been physically
present in the United States for five years, two years of which were after the age of 14. The information
provided here should describe, the U.S. citizen grandfather or U.S. grandmother of the minor child.)
A.

Current legal name of U.S. citizen grandfather or grandmother.
Family Name (Last Name)

Given Name (First Name)

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

C.

Full Middle Name (If applicable)

Country of Birth

D. Home Address - Street Number and Name
City

E.

Apartment Number

County

State or Province

Country

Zip Code

U.S. citizen by:
Birth in the United States
Naturalization
Date of Naturalization (mm/dd/yyyy)

Place of Naturalization
(Name of Court and City/State or (USCIS or former INS) Office Location)

Certificate of Naturalization Number

Former "A" Number (If known)

Through birth abroad to U.S. citizen parent(s)
Acquired after birth through naturalization of alien parent(s)
F.

Has your father or mother (your child's grandfather or grandmother) ever lost U.S. citizenship or taken any action that
would cause loss of U.S. citizenship?
No

G.

Yes (Please provide full explanation.)

Dates of Residence and/or Physical Presence in the United States
Provide the dates that your U.S. citizen father or mother (your child's grandfather or grandmother) lived in the United States. If you need
more space, use a separate sheet of paper.
From (Month/Day/Year - mm/dd/yyyy)

To (Month/Day/Year - mm/dd/yyyy)

Form N-600K (Rev. 09/06/07)Y Page 4

Part 6. Legal guardian. (Complete this part only for applications filed by a legal guardian in lieu of a deceased
U.S. citizen parent.)
A.

Current legal name of U.S. citizen Legal Guardian.
Family Name (Last Name)

Given Name (First Name)

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

C.

Full Middle Name (If applicable)

Country of Birth

D. Home Address - Street Number and Name

City

E.

Apartment Number

County

State or Province

Country

Zip Code

U.S. citizen by:
Birth in the United States
Naturalization
Date of Naturalization (mm/dd/yyyy)

Place of Naturalization (Name of Court & City/State or USCIS or former INS Office Location)

Certificate of Naturalization Number

Former "A" Number (If known)

Through birth abroad to United States citizen parent(s)
Acquired after birth through naturalization of alien parent(s)
F.

Date of Legal Guardianship

G.

Name of Authority that Granted Legal Guardianship

H.

Address of Authority that Granted Legal Guardianship

Part 7. Your Signature.
I certify, under penalty of perjury under the laws of the United States, that this application, and the evidence submitted with it, is all true and
correct. I authorize the release of any information from my records that U.S. Citizen and Immigration Services needs to determine eligibility
for the benefit I am seeking.
Applicant's Signature

Print Name

Date (mm/dd/yyyy)

Form N-600K (Rev. 09/06/07)Y Page 5

Part 8. Signature of person preparing this form, if other than above.
I declare 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 questions contained on this form.
Preparer's Printed Name

Preparer's Signature

Name of Business/Organization (If Applicable)

Preparer's Daytime Phone Number

Date (mm/dd/yyyy)

Preparer's Address - Street Number and Name

City

County

State

Zip Code

NOTE: Do not complete the following parts below unless the USCIS officer instructs you to do so at the interview.

Part 9. Affidavit.
I, the parent/grandparent/legal guardian,

do swear or affirm, under penalty of perjury laws of the

United States, that I know and understand the contents of this application signed by me, and the attached supplementary pages number (
(

) inclusive, that the same are true and correct to the best of my knowledge, and that corrections number (

) to (

) to

) were made by

me or at my request.
Signature of U.S. citizen parent/grandparent/legal guardian

Date (mm/dd/yyyy)

Subscribed and sworn or affirmed before me upon examination of the applicant and U.S. citizen parent/grandparent/legal guardian on

.

at
Signature of Interviewing Officer

Title

Form N-600K (Rev. 09/06/07)Y Page 6

Part 10. Officer Report and Recommendation.
On the basis of the documents, records, and the testimony of persons examined, and the identification upon personal appearance of the underage
beneficiary, I find that all the facts and conclusions set forth under oath in this application are
to be naturalized on
residence)

true and correct; that the applicant is eligible

(month/day/year), through section 322 of the INA
section 322 of the INA (grandparent or legal guardian application)

and I recommend that this application be

; section 322 of the INA (grandparent
.

(granted or denied) and that a Certificate of Citizenship be issued in the name of

.
District Adjudications Officer's Name and Title

District Adjudications Officer's Signature

I do

Date:

concur in recommendation of the application.

(mm/dd/yyyy)
District Director or Officer-in-Charge Signature:

Form N-600K (Rev. 09/06/07)Y Page 7