Form N-644 Application for Posthumous Citizenship

OMB No. 1615-0059; Expires 09/30/2012

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)

8. 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 U.S. Embassy or Consulate

4. Date of Birth

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

(

Spouse

b.

Parent

c.

Son/Daughter

d.

Brother/Sister

Representative

5. A-Number, if applicable

7. Telephone Number (Include Area/Country Code)

a.

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)

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.)

8.

A-Number or Other USCIS File Number

9.

U.S. Social Security Number (If any)

2. Other Names Used

3. Date of Birth (mm/dd/yyyy) 4. Place of Birth (City/State/Country)

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

Form N-644 (08/01/12) Y

B. Information About the Decedent (Continued)
10. Father's Full Name

11. Mother's Maiden Name

Living

B.

Deceased

Name (Last/First/Middle)

Living

Deceased
Date of Birth (mm/dd/yyyy)

Living
Deceased

C.

Living

Deceased

Name (Last/First/Middle)

12. Marital Status at Time of Death
a. Married

c. Widowed

b. Divorced

d. Single

D.

Living

Date of Birth (mm/dd/yyyy)

Deceased

Name (Last/First/Middle)

Date of Birth (mm/dd/yyyy)

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

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

Living

Deceased

Name (Last/First/Middle)

Date of Birth (mm/dd/yyyy)

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

Name (Last/First/Middle)

Date of Birth (mm/dd/yyyy)

20. Retired From Military?

19. Military Rank at Time of
Discharge

Yes

No

B.

Living

21. VA Claim Number (If any)

Name (Last/First/Middle)

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

C.

Living

Deceased
Date of Birth (mm/dd/yyyy)

Deceased

Name (Last/First/Middle)

Date of Birth (mm/dd/yyyy)

23. Complete the Following for Each Child
A.

Living

Name (Last/First/Middle)

D.

Deceased
Date of Birth (mm/dd/yyyy)

Living

Name (Last/First/Middle)

Deceased
Date of Birth (mm/dd/yyyy)

Form N-644 (08/01/12) Y Page 2

B. Information About the Decedent (Continued)
Certificate of Applicant
E.

Living

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

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
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

6. Individual Entered Service Under the Lodge Act?
Yes

No

Unable to Determine

Record of Death Found
(Complete a and b)

7.

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

(List name shown in records)

5.

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

Active Duty Service Records Found
(Complete a through f)

Yes
a. Branch of Service

No

Unable to Determine

8. Certification
I certify the information given here concerning the

b. Date Entered Active Duty

(Check one or both, as appropriate)
Service

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

Death

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

d. Service Number

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

Signature

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

Title

Yes

No

Date
Phone number

E-mail address

Form N-644 (08/01/12) Y Page 3

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:
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

Signature

Signature

Date

Title

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

Sent

Completed
App'd

Denied

Ret'd

Form N-644 (08/01/12) Y Page 4