Form N-25 Request for Certification of Naturalization

OMB No. 1615-0049: Expires 04/30/2012

N-25, Request for
Verification of Naturalization

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

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Date

CLERK,

File No.
Name of Applicant

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Approximate Date of
Naturalization

Name of Subject

Native of

The person named above may have been naturalized in your court. If your records show that this person was naturalized, please fill in the blocks
as completely as your records permit. If no naturalization record is found, write "No Record" above your signature. However, if a Declaration of Intention
was filed, please fill in the lower block. If the subject's signature is available, please make one tracing on thin paper and return it with this report. The
information is requested for the official use of U.S. Citizenship and Immigration Services (USCIS).

Sincerely,
Name of Naturalized Person as Shown in Court Records
Application Number

Date of Naturalization

Certificate Number

Court (Title and Location)

Date and Place of Birth (or Age)

Former Allegiance

Place of Residence

Occupation

Date, Place, and Manner of Arrival in the United States
Marital Status

Name of Spouse

Names of Children, Dates and Places of Birth

Other Information Appearing in Record

Declaration of Intention Filed
(Date)
Age or Date of Birth

Signature and Title of Person Verifying Report
Date
Form N-25 (Rev. 04/30/09)Y

Reporting Burden.
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 15 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 Products Division, 111 Massachusetts Avenue, N.W., 3rd floor,
Suite 3008, Washington, D.C. 20529-2210; OMB No. 1615-0049. Do not mail your completed application to this address.

Form N-25 (Rev. 04/30/09)Y