Form N-644 Application for Posthumous Citizenship

DRAFT - Not For Production

OMB No. 1615-0059; Expires 09/30/2010

N-644, Application for
Posthumous Citizenship

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

For USCIS Only
Fee Stamp

Part I.

Information About the Applicant (To be completed by the applicant only)

1. Name (Last/First/Middle)

8. Your Relationship to Decedent at Time of His/Her Death
(Check one)

2. Address (Street Name and Number)

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

3. If Abroad, City/Country of Nearest U.S. Embassy or Consulate

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

5. A-Number, if applicable

a.

Spouse

b.

Parent

c.

Son/Daughter

d.

Brother/Sister

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)

h.

The Secretary of Defense or the Secretary's designee
with USCIS after a request by the next-of-kin

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

7. Telephone Number (Include Area/Country Code)
(

9. E-mail Address

)

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

7.

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

3. Date of Birth (mm/dd/yyyy) 5. Place of Birth (City, State, Country)

8.

A-Number or Other USCIS File Number

4. Date of Death (mm/dd/yyyy) 6. Place of Death (City, State, Country)

9.

U.S. Social Security Number (If any)

2. Other Name(s) Used

Form N-644 (Rev. 07/09/10) Y

DRAFT - Not For Production
B. Information About the Decedent (continued)
10. Father's Full Name

Living

B.

Deceased
Date of Birth (mm/dd/yyyy)

Name (Last/First/Middle)

Deceased
11. Mother's Maiden Name

Living

Living
Deceased

C.

Living

Deceased
Date of Birth (mm/dd/yyyy)

Name (Last/First/Middle)

12. Marital Status at Time of Death
a. Married

c. Widowed

b. Divorced

d. Single

D.

Living

Deceased
Date of Birth (mm/dd/yyyy)

Name (Last/First/Middle)
13. Military Service Serial Number (If different from Social Security #)

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

Living

Deceased
Date of Birth (mm/dd/yyyy)

Name (Last/First/Middle)

15. Place Entered Active Duty Service (City/State/Country)
24. Total Number of Brothers and Sisters (If none, write "None")
16. Date Released From Active Duty Service (mm/dd/yyyy)
25. Complete the Following for Each Brother and Sister
17. Branch of Service

18. Type of Discharge

A.

Living

Deceased
Date of Birth (mm/dd/yyyy)

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

20. Retired From Military?
Yes

No

21. VA Claim Number (If any)

B.

Living

Deceased
Date of Birth (mm/dd/yyyy)

Name (Last/First/Middle)

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

Living

Deceased
Date of Birth (mm/dd/yyyy)

Name (Last/First/Middle)
23. Complete the Following for Each Child
A.

Living

Name (Last/First/Middle)

Deceased
Date of Birth (mm/dd/yyyy)

D.

Living

Name (Last/First/Middle)

Deceased
Date of Birth (mm/dd/yyyy)

Form N-644 (Rev. 07/09/10) Y Page 2

DRAFT - Not For Production
B. Information About the Decedent (continued)
E.

Living

Certificate of Applicant

Deceased

Name (Last/First/Middle)

Date of Birth (mm/dd/yyyy)

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(mm/dd/yyy)

Signature
F.

Living

Deceased

Name (Last/First/Middle)

G.

Living

Date of Birth (mm/dd/yyyy)

Address (Street Number and Name, City/Town, State/Province,
Country, Zip-Postal Code

Deceased

Name (Last/First/Middle)

Name (Print or Type)

Date of Birth (mm/dd/yyyy)

Part II. To Be Completed by the Applicable Executive Department
6. Individual Entered Service Under the Lodge Act?

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

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

(List name shown in records)

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

5.

No

Yes

Unable to Determine

Record of Death Found (Complete a and b)

7.

Active Duty Service Records Found
(Complete a through f)

Yes

No

Unable to Determine

8. Certification
a. Branch of Service

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

b. Date Entered Active Duty

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

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

d. Service Number

Signature

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

Name (Print or Type)

f. Honorable Service During a Period of Hostilities
(If no is checked, please provide an explanation)

Title

Yes

No

Death

Service

Date (mm/dd/yyyy)

Telephone Number (Include
area/country code)

E-mail address (If any)

Form N-644 (Rev 07/09/10) Y Page 3

DRAFT - Not For Production
Part III.

To Be Completed by the Department of Defense, Washington Headquarters Services, Directorate for
Information Operations and Reports
Unable to Certify

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:
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.
Date (mm/dd/yyyy)

Signature

Signature

Date (mm/dd/yyyy)

Name (Print or Type)

Name (Print or Type)
Title
Title

Part IV. To be Completed by U.S. Citizenship and Immigration Services Only
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

Certificate Number:

Date Mailed (mm/dd/yyyy)

A Number:

Registered Mail Number:

Initial Receipt

Resubmitted

Relocated
Rec'd

Completed

Sent

App'd Denied

Ret'd

Form N-644 (Rev. 07/09/10) Y Page 4