Table of changes form

TABLE OF CHANGES – FORM

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

OMB Number: 1615-0087

REV+FR (021317-N)

11/21/2016

Reason for Revision: Updating standard language, incorporating Fee Rule information.

Current Page Number and Section	Current Text	Proposed Text
	[Page 1] Print or type your answers fully and accurately in black ink. Write “N/A” if an item is not applicable. Write “None” if the answer is none. Failure to answer all of the questions may delay your Form N-600K.	[Page 1] To be completed by an Attorney or BIA-Accredited Representative (if any). Select this box if Form G-28 is attached. Attorney State Bar Number (if applicable) Attorney or Accredited Representative USCIS Online Account Number (if any) START HERE - Type or print in black ink.
Page 1, Part 1. Information About Your Eligibility	[Page 1] Part 1. Information About Your Eligibility (check only one box) The application is being filed on your behalf. You are under 18 years of age and: 1. The BIOLOGICAL child of a qualifying U.S. citizen (USC) parent filing this form. 2. The ADOPTED child of a qualifying USC parent filing this form. 3. The grandchild of a qualifying USC grandparent or the child ward of a USC legal guardian filing this form within 5 years of the death of my USC parent.	[Page 1] Part 1. Information About the Child’s Eligibility 1. The application is being filed for a child. The child is under 18 years of age and (Select only one box): [] The BIOLOGICAL child of a qualifying U.S. citizen (USC) parent filing this application. [] The ADOPTED child of a qualifying USC parent filing this application. [] The grandchild of a qualifying USC grandparent or the child ward of a USC legal guardian filing this application within five years of the death of the USC parent.
Page 1, Part 2. Information About You, the Child (for whom this application is being filed)	[Page 1] Part 2. Information About You, the Child (for whom this application is being filed) 1. Current Legal Name (do not provide a nickname) Family Name (last name) Given Name (first name) Middle Name (if applicable) 2.   Name exactly as it appears on your Permanent Resident Card (if applicable) Family Name (last name) Given Name (first name) Middle Name (if applicable) 3. Other name(s) you have used since birth (if applicable. Include nicknames.) Family Name (last name) Given Name (first name) Middle Name (if applicable) 4. U.S. Social Security Number (if applicable) [new] 5. Date of Birth (mm/dd/yyyy) 6. Country of Birth 7. Country of Citizenship/Nationality 8. Gender Male/Female 9. Height Feet/Inches 10. Home Address Street Number and Name (do not provide a P.O. Box in this space unless it is your ONLY address.) Apartment Number City State ZIP Code Province (foreign address only) Country (foreign address only) Postal Code (foreign address only) [Page 2] 11. Mailing Address C/O (in care of name) Street Number and Name City State ZIP Code Province (foreign address only) Country (foreign address only) Postal Code (foreign address only) 14. Marital Status Single, Never Married Married Divorced Widowed Marriage Annulled Other (explain): 15.  Information about your admission into the United States and current immigration status (Do NOT complete this section. The USCIS officer will complete it with you during the interview.) You arrived in the following manner: Port of Entry (City/State) Date of Entry (mm/dd/yyyy) Exact Name Used at Time of Entry Current Immigration Status 16. Do you know of any prior application for citizenship or for a U.S. passport? 17. Were you adopted? Date of Adoption (mm/dd/yyyy) Date Legal Custody Began (mm/dd/yyyy) Date Physical Custody Began (mm/dd/yyyy) 18. Were your parents married to each other when you were born (or adopted)?	[Page 1] Part 2. Information About the Child (for whom this application is being filed) 1.   Current Legal Name (do not provide a nickname) Family Name (Last Name) Given Name (First Name) Middle Name 2.   Your Name Exactly As It Appears on the Permanent Resident Card (if applicable) Family Name (Last Name) Given Name (First Name) Middle Name 3. Other Names Used (if applicable) Provide all other names you have ever used, including nicknames, maiden name, and aliases. Family Name (Last Name) Given Name (First Name) Middle Name 4. U.S. Social Security Number (if applicable) 5. USCIS Online Account Number (if any) 6. Date of Birth (mm/dd/yyyy) 7. Country of Birth [Page 2] 8. Prior Country of Citizenship or Nationality 9. Gender Male/Female 10. Height Feet/Inches 11. Mailing Address In Care Of Name (if any) Street Number and Name Apt. Ste. Flr. City or Town State ZIP Code Province Postal Code Country 12. Physical Address (Do not provide a PO Box in this space unless it is the ONLY address.) Street Number and Name Apt. Ste. Flr. City or Town State ZIP Code Province Postal Code Country 13. Marital Status Single, Never Married Married Divorced Widowed Separated Marriage Annulled Other (Explain): 14.  Information About the Admission Into the United States and Current Immigration Status NOTE: Do NOT complete this section. The USCIS officer will complete it during the interview. Arrived in the following manner: A. Port-of-Entry City or Town State Date of Entry (mm/dd/yyyy) Exact Name Used at Time of Entry Family Name (Last Name) Given Name (First Name) Middle Name B. Current Immigration Status 15. Was there any prior application for citizenship or for a U.S. passport? Yes/No [Page 3] 16. Was the child adopted? A. Date of Adoption (mm/dd/yyyy) B. Date Legal Custody Began (mm/dd/yyyy) C. Date Physical Custody Began (mm/dd/yyyy) 17. Were the child’s parents married to each other when the child was born (or adopted)? Yes/No
Page 2, Part 3.  Information About Your U.S. Citizen Biological or Adoptive Parent (Provide information about yourself below if you are a U.S. citizen father or mother applying on behalf of your eligible child. Provide information about the child's U.S. citizen parent in the sections noted if you are the U.S. citizen grandparent or legal guardian.)	[Page 2] Part 3.  Information About Your U.S. Citizen Biological or Adoptive Parent (Provide information about yourself below if you are a U.S. citizen father or mother applying on behalf of your eligible child. Provide information about the child's U.S. citizen parent in the sections noted if you are the U.S. citizen grandparent or legal guardian.) 1. Current legal name of U.S. citizen father or mother submitting this Form N-600K. Family Name (last name) Given Name (first name) Middle Name (if applicable) [page 3] 2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. U.S. Social Security Number (if applicable) 5.   Home Address Street Number and Name (do not provide a P.O. Box in this space) Apartment Number City State ZIP Code Province (foreign address only) Country (foreign address only) Postal Code (foreign address only) 6. Daytime Phone Number Work Phone Number (if any) Evening Phone Number Mobile Phone Number (if any) 7. E-Mail Address (if any) 8. Your parent is a U.S. citizen by: Birth in the United States Acquisition after birth through naturalization of alien parent(s) Birth abroad to U.S. citizen parent(s) Certificate of Citizenship Number A-Number (if known) Naturalization Place of Naturalization (name of court and City/State or USCIS office location) Certificate of Naturalization Number A-Number (if known) Date of Naturalization (mm/dd/yyyy) 9. Has your U.S. citizen father or mother ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship? Yes (provide full explanation on an additional sheet(s) of paper.) No 10. Marital History A. How many times has your U.S. citizen father or mother been married (including annulled marriages and marriage(s) to the same person)? B. What is your U.S. citizen father or mother's current marital status? Single, Never Married Married Divorced Widowed Marriage Annulled Other (explain): C.  Information about your U.S. citizen father's or mother's current spouse: Family Name (last name) Given Name (first name) Middle Name (if applicable) Date of Birth (mm/dd/yyyy) Country of Birth Country of Citizenship/Nationality [page 2] Spouse's Home Address Street Number and Name (do not provide a P.O. Box in this space) Apartment Number City State ZIP Code Province (foreign address only) Country (foreign address only) Postal Code (foreign address only) Date of Marriage (mm/dd/yyyy) Place of Marriage (City/State or Country) Spouse's Immigration Status U.S. Citizen Permanent Resident Other (explain): D. Is your U.S. citizen father's or mother's current spouse also your biological (or adopted) parent? 11. Member of U.S. Armed Forces A. Is the sponsoring U.S. citizen parent a member of the U.S. Armed Forces? Yes/No B. If you answered yes, then are you are on official orders authorizing you to accompany and reside with your sponsoring U.S. citizen parent who is a member of the U.S. Armed Forces? Yes/No NOTE: If your U.S. citizen biological or adoptive parent is filing this application AND has the required physical presence in the United States, skip Part 4 and go directly to Part 5.	[Page 3] Part 3.  Information About the Child’s U.S. Citizen Biological or Adoptive Parent NOTE: Provide information about the U.S. citizen father or mother applying on behalf of the eligible child. Provide information about the child's U.S. citizen parent in the sections noted if the U.S. citizen grandparent or legal guardian is filing this form. 1. Current Legal Name of U.S. Citizen Parent Family Name (Last Name) Given Name (First Name) Middle Name 2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. U.S. Social Security Number (if applicable) 5.   Physical Address Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.) Apt. Ste. Flr. City or Town State ZIP Code Province Postal Code Country 6. Daytime Telephone Number 7. Work Telephone Number (if any) 8. Evening Telephone Number 9. Mobile Telephone Number (if any) 10. Email Address (if any) [Page 4] 11. The parent is a U.S. citizen by: Birth in the United States Acquisition after birth through naturalization of alien parents Birth abroad to U.S. citizen parents Certificate of Citizenship Number Alien Registration Number (A-Number) (if known) Naturalization Place of Naturalization Name of Court or USCIS Office Location City or Town State Certificate of Naturalization Number A-Number (if known) Date of Naturalization (mm/dd/yyyy) 12. Has the U.S. citizen father or mother ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship? Yes No If the answer is “Yes” to Item Number 12., provide a full explanation in the space provided in Part 11. Additional Information. 13. Marital History A. How many times has the U.S. citizen father or mother been married (including annulled marriages and marriages to the same person)? B. What is the U.S. citizen father or mother's current marital status? Single, Never Married Married Divorced Widowed Separated Marriage Annulled Other (Explain): C.  Information About the U.S. Citizen Father's or Mother's Current Spouse Family Name (Last Name) Given Name (First Name) Middle Name Date of Birth (mm/dd/yyyy) Country of Birth Country of Citizenship or Nationality Spouse's Physical Address Street Number and Name (Do not provide a PO Box in this space unless it is your spouse’s ONLY address.) Apt. Ste. Flr. City or Town State ZIP Code Province Postal Code Country [Page 5] Date of Marriage (mm/dd/yyyy) Place of Marriage City or Town State Country Spouse's Immigration Status U.S. Citizen Lawful Permanent Resident Other (Explain): D. Is the U.S. citizen father's or mother's current spouse also the child’s biological (or adoptive) parent? 14. Member of U.S. Armed Forces A. Is the sponsoring U.S. citizen parent a member of the U.S. Armed Forces? Yes/No B. If the answer is “Yes,” then are there official orders authorizing the child to accompany and reside with the sponsoring U.S. citizen parent who is a member of the U.S. Armed Forces? Yes/No NOTE: If the U.S. citizen biological or adoptive parent is filing this application AND has the required physical presence in the United States, skip Part 4. and go directly to Part 5.
Page 4, Part 4. Information About Your Qualifying U.S. Citizen Grandparent (complete this part only if your U.S. citizen parent (or adoptive parent), grandparent, or legal guardian is applying for citizenship for you, and the U.S. citizen parent has not been physically present in the United States for 5 years; 2 years of which were after the age of 14.)	[page 4] Part 4. Information About Your Qualifying U.S. Citizen Grandparent (complete this part only if your U.S. citizen parent (or adoptive parent), grandparent, or legal guardian is applying for citizenship for you, and the U.S. citizen parent has not been physically present in the United States for 5 years; 2 years of which were after the age of 14.) 1. Current legal name of U.S. citizen grandfather or grandmother submitting this Form N-600K. Family Name (last name) Given Name (first name) Middle Name (if applicable) 2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. U.S. Social Security Number (if applicable) 5.   Home Address Street Number and Name (do not provide a P.O. Box in this space) Apartment Number City State ZIP Code Province (foreign address only) Country (foreign address only) Postal Code (foreign address only) [page 5] 6. Daytime Phone Number Work Phone Number (if any) Evening Phone Number Mobile Phone Number (if any) 7. E-Mail Address (if any) 8. My grandparent is a U.S. citizen by: Birth in the United States Acquisition after birth through naturalization of alien parent(s) Birth abroad to U.S. citizen parent(s) Certificate of Citizenship Number A-Number (if known) Naturalization Place of Naturalization (name of court and City/State or USCIS office location) Certificate of Naturalization Number A-Number (if known) Date of Naturalization (mm/dd/yyyy) 9. Has your grandparent ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship? Yes (provide full explanation on an additional sheet(s) of paper) No	[Page 5] Part 4. Information About the Child’s Qualifying U.S. Citizen Grandparent NOTE: Complete this part only if the U.S. citizen parent (or adoptive parent), grandparent, or legal guardian is applying for citizenship for the child, and the U.S. citizen parent has not been physically present in the United States for five years; two years of which were after 14 years of age.) 1. Current Legal Name of U.S. Citizen Grandparent Family Name (Last Name) Given Name (First Name) Middle Name 2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. U.S. Social Security Number (if applicable) 5.   Physical Address Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.) Apt. Ste. Flr. City or Town State ZIP Code Province Postal Code Country 6. Daytime Telephone Number 7. Work Telephone Number (if any) 8. Evening Telephone Number 9. Mobile Telephone Number (if any) 10. Email Address (if any) 11. The grandparent is a U.S. citizen by: Birth in the United States Acquisition after birth through naturalization of alien parents Birth abroad to U.S. citizen parents Certificate of Citizenship Number A-Number (if known) Naturalization Place of Naturalization (Name of Court or USCIS Office Location) City or Town State Certificate of Naturalization Number A-Number (if known) Date of Naturalization (mm/dd/yyyy) 12. Has the grandparent ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship? Yes/No If the answer is “Yes” to Item Number 12., provide a full explanation in the space provided in Part 11. Additional Information.
Page 5, Part 5. Physical Presence in the United States From Birth Until Filing of Form N-600K (Provide the dates that your U.S. citizen parent or grandparent was present in the United States. If your U.S. citizen parent has not been physically present in the United States for 5 years, 2 years of which were after the age of 14, then you must use the physical presence of your U.S. citizen grandparent.)	[Page 5] Part 5. Physical Presence in the United States From Birth Until Filing of Form N-600K (Provide the dates that your U.S. citizen parent or grandparent was present in the United States. If your U.S. citizen parent has not been physically present in the United States for 5 years, 2 years of which were after the age of 14, then you must use the physical presence of your U.S. citizen grandparent.) Indicate whether this information relates to your U.S. citizen parent or to your qualifying grandparent U.S. Citizen Parent U.S. Citizen Grandparent Physical Presence in the United States (mm/dd/yyyy) From/Until From/Until From/Until From/Until From/Until From/Until From/Until From/Until NOTE: If your U.S. citizen biological/adoptive parent is filing this application, skip Part 6 and go directly to Part 7.	[Page 6] Part 5. Physical Presence in the United States From Birth Until Filing of Form N-600K NOTE: Provide the dates that the U.S. citizen parent or grandparent was present in the United States. If the U.S. citizen parent has not been physically present in the United States for five years, two years of which were after 14 years of age, then the child must use the physical presence of the U.S. citizen grandparent. 1. Indicate whether this information relates to the U.S. citizen parent or to the qualifying grandparent. U.S. Citizen Parent U.S. Citizen Grandparent 2. Physical Presence in the United States (mm/dd/yyyy) A. From (mm/dd/yyyy) To (mm/dd/yyyy) B. From (mm/dd/yyyy) To (mm/dd/yyyy) C. From (mm/dd/yyyy) To (mm/dd/yyyy) D. From (mm/dd/yyyy) To (mm/dd/yyyy) E. From (mm/dd/yyyy) To (mm/dd/yyyy) F. From (mm/dd/yyyy) To (mm/dd/yyyy) G. From (mm/dd/yyyy) To (mm/dd/yyyy) H. From (mm/dd/yyyy) To (mm/dd/yyyy) NOTE: If the U.S. citizen biological/adoptive parent is filing this application, skip Part 6. and go directly to Part 7.
Page 6, Part 6. Information About Your Legal Guardian (complete this part only if your legal guardian is filing this application in lieu of a deceased U.S. citizen parent)	[Page 6] Part 6. Information About Your Legal Guardian (complete this part only if your legal guardian is filing this application in lieu of a deceased U.S. citizen parent) 1. Current legal name of U.S. citizen father or mother submitting this Form N-600K. Family Name (last name) Given Name (first name) Middle Name (if applicable) 2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. U.S. Social Security Number (if applicable) 5.   Home Address Street Number and Name (do not provide a P.O. Box in this space) Apartment Number City State ZIP Code Province (foreign address only) Country (foreign address only) Postal Code (foreign address only) 6. Daytime Phone Number Work Phone Number (if any) Evening Phone Number Mobile Phone Number (if any) 7. E-Mail Address (if any) 8. My legal guardian is a U.S. citizen by: Birth in the United States Acquisition after birth through naturalization of alien parent(s) Birth abroad to U.S. citizen parent(s) Certificate of Citizenship Number A-Number (if known) Naturalization Place of Naturalization (name of court and City/State or USCIS office location) Certificate of Naturalization Number A-Number (if known) Date of Naturalization (mm/dd/yyyy) 9. Date of Legal Guardianship (mm/dd/yyyy) 10. Name of Authority that Granted Legal Guardianship 11. Address of Authority that Granted Legal Guardianship	[Page 7] Part 6. Information About the Legal Guardian NOTE: Complete this part only if your legal guardian is filing this application in lieu of a deceased U.S. citizen parent. 1. Current Legal Name of the Legal Guardian Family Name (Last Name) Given Name (First Name) Middle Name 2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. U.S. Social Security Number (if applicable) 5.   Physical Address Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.) Apt. Ste. Flr. City or Town State ZIP Code Province Postal Code Country 6. Daytime Telephone Number 7. Work Telephone Number (if any) 8. Evening Telephone Number 9. Mobile Telephone Number (if any) 10. Email Address (if any) 11. The legal guardian is a U.S. citizen by: Birth in the United States Acquisition after birth through naturalization of alien parents Birth abroad to U.S. citizen parents Certificate of Citizenship Number A-Number (if known) Naturalization Place of Naturalization Name of Court or USCIS Office Location City or Town State Certificate of Naturalization Number A-Number (if known) Date of Naturalization (mm/dd/yyyy) 12. Date of Legal Guardianship (mm/dd/yyyy) 13. Name of Authority that Granted Legal Guardianship 14. Address of Authority that Granted Legal Guardianship Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.) Apt. Ste. Flr. City or Town State ZIP Code Province Postal Code Country
Page 6, Part 7. Preferred Location and Date for Interview	[page 6] Part 7. Preferred Location and Date for Interview 1. Location (USCIS Office, City, or State 2. Preferred Date (mm/dd/yyyy) USCIS will attempt to accommodate your preferences. NOTE: Interview date should be at least 90 days after filing Form N-600K and before your (the child's) 18th birthday.	[page 8] Part 7. Preferred Location and Date for Interview 1. USCIS Office Location City or Town State 2. Preferred Date (mm/dd/yyyy) USCIS will attempt to accommodate the requested preferences. NOTE: Interview date should be at least 90 days after filing Form N-600K and before the child's 18th birthday.
Page 7, Part 8. Your Signature (USCIS will reject your Form N-600K if it is not signed.)	[Page 7] Part 8. Your Signature (USCIS will reject your Form N-600K if it is not signed.) 12. Daytime Phone Number Work Phone Number (if any) Evening Phone Number Mobile Phone Number (if any) 13. E-Mail Address (if any) 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. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking. Your Signature Date (mm/dd/yyyy)	[Page 8] Part 8. Applicant’s Statement, Contact Information, Certification, and Signature NOTE: Read the Penalties section of the Form N-600K Instructions before completing this part. Applicant’s Statement NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. 1. Applicant’s Statement Regarding the Interpreter A. [] I can read and understand English, and I have read and understand every question and instruction on this application and my answer to every question. B. [] The interpreter named in Part ­9. read to me every question and instruction on this application and my answer to every question in [Fillable Field], a language in which I am fluent, and I understood everything. 2. Applicant’s Statement Regarding the Preparer []At my request, the preparer named in Part 10., [Fillable Filed], prepared this application for me based only upon information I provided or authorized. Applicant’s Contact Information 3. Applicant’s Daytime Telephone Number 4. Applicant’s Mobile Telephone Number (if any) 5. Applicant’s Email Address (if any) Applicant’s Certification Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of my records that USCIS may need to determine my eligibility for the immigration benefit I seek. I further authorize release of information contained in this application, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws. I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that: 1) I reviewed and provided or authorized all of the information in my application; 2) I understood all of the information contained in, and submitted with, my application; and 3) All of this information was complete, true, and correct at the time of filing. [Page 9] I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the information contained in, and submitted with, my application, and that all of this information is complete, true, and correct. Applicant’s Signature 6 Applicant’s Signature Date of Signature (mm/dd/yyyy) NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, USCIS may deny your application.
		[Page 9] [New] Part 9. Interpreter’s Contact Information, Certification, and Signature Provide the following information about the interpreter. Interpreter’s Full Name 1. Interpreter’s Family Name (Last Name) Interpreter’s Given Name (First Name) 2. Interpreter’s Business or Organization Name (if any) [Page 10] Interpreter’s Mailing Address 3. Street Number and Name [ ] Apt. [ ] Ste. [ ] Flr. City or Town State ZIP Code Province Postal Code Country Interpreter’s Contact Information 4. Interpreter’s Daytime Telephone Number 5. Interpreter’s Mobile Telephone Number (if any) 6. Interpreter’s Email Address (if any) Interpreter’s Certification I certify, under penalty of perjury, that: I am fluent in English and [Fillable Field], which is the same language specified in Part 8., Item B. in Item Number 1., and I have read to this applicant in the identified language every question and instruction on this application and his or her answer to every question. The applicant informed me that he or she understands every instruction, question, and answer on the application, including the Applicant’s Certification, and has verified the accuracy of every answer. Interpreter’s Signature 7. Interpreter’s Signature Date of Signature (mm/dd/yyyy)
Page 7, Part 9. Signature of Person Who Prepared This Form For You (if applicable)	[Page 7] Part 9. Signature of Person Who Prepared This Form For You (if applicable) Preparer's Printed Name Preparer's Firm or Organization Name (if applicable) Preparer's Address Street Number and Name (do not provide a P.O. Box in this space) Apartment Number City State ZIP Code Province (foreign address only) Country (foreign address only) Postal Code (foreign address only) Preparer's Daytime Phone Number Preparer's Fax Number Preparer's Email Address NOTE: Do not complete the part below until the USCIS officer instructs you to do so at the interview. 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 application. Preparer's Signature Date (mm/dd/yyyy)	[Page 10] Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant Provide the following information about the preparer. Preparer’s Full Name 1. Preparer’s Family Name (Last Name) Preparer’s Given Name (First Name) 2. Preparer’s Business or Organization Name (if any) [Page 11] Preparer’s Mailing Address 3. Street Number and Name [ ] Apt. [ ] Ste. [ ] Flr. City or Town State ZIP Code Province Postal Code Country Preparer’s Contact Information 4. Preparer’s Daytime Telephone Number 5. Preparer’s Mobile Telephone Number (if any) 6. Preparer’s Email Address (if any) [page 11] Preparer’s Statement 7. A. [] I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant’s consent. B. [] I am an attorney or accredited representative and my representation of the applicant in this case [] extends [] does not extend beyond the preparation of this application. NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this application, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application. [Deleted] Preparer’s Certification By my signature, I certify, penalty of perjury, that I prepared this application at the request of the applicant. The applicant then reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted with, his or her application, including the Applicant’s Certification, and that all of this information is complete, true, and correct. I completed this application based only on information that the applicant provided to me or authorized me to obtain or use. Preparer’s Signature 8. Preparer’s Signature Date of Signature (mm/dd/yyyy)
		[Page 12] [New] Part 11. Additional Information If you need extra space to provide any additional information within this application, use the space below. If you need more space than what is provided, make copies of this page to complete and file with this application or attach a separate sheet of paper. Type or print the applicant’s name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which the answer refers; and sign and date each sheet. 1. Family Name (Last Name) Given Name (First Name) Middle Name 2. A-Number (if any) 3. A. Page Number B. Part Number C. Item Number D. [Fillable field] 4. A. Page Number B. Part Number C. Item Number D. [Fillable field] 5. A. Page Number B. Part Number C. Item Number D. [Fillable field] 6. A. Page Number B. Part Number C. Item Number D. [Fillable field] 7. A. Page Number B. Part Number C. Item Number D. [Fillable field]
Page 7, Part 10. Affidavit	[page 7] Part 10. Affidavit I, the parent/grandparent/legal guardian, _____ do swear or affirm, under penalty of perjury under the laws of the United States, that I know and understand the contents of this application signed by me, and the attached supplementary pages number ( ) to ( ) inclusive, that the same are true and correct to the best of my knowledge, and that corrections number ( ) to ( ) were made by me or at my request. Applicant, Parent or Legal Guardian's Signature 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 _____. Interviewing USCIS Officer's Name and Title Interviewing USCIS Officer's Signature	[page 13] Part 12. Affidavit (At the time of Interview) [No Change] Applicant’s, Parent’s, or Grandparent’s or Legal Guardian's Signature Date of Signature (mm/dd/yyyy) Subscribed and sworn or affirmed before me upon examination of the applicant (U.S. citizen parent, grandparent, or legal guardian) on Date (mm/dd/yyyy) ____ at _____ (Location). Interviewing USCIS Officer’s Name Interviewing USCIS Officer’s Title Interviewing USCIS Officer's Signature Date of Signature (mm/dd/yyyy)
Page 8, Part 11. USCIS Officer Report and Recommendation	[page 8] Part 11. USCIS Officer Report and Recommendation On the basis of the documents, records and the testimony of person 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: 1. true and correct; 2. The applicant derived or acquired U.S. citizenship on (mm/dd/yyyy) 3. The applicant derived or acquired U.S. citizenship through (select the box next to the appropriate section of law or, if the section of law is not reflected, type or print the applicable section of law in the space next to “Other”) INA Section 322(a)(2)(A) of the (Parent residence); INA Section 322(a)(2)(B) of the (Grandparent residence); or Other _____ I recommend that this Form N-600K be: Approved Denied Issue Certificate of Citizenship in the Name of USCIS Officer's Name and Title USCIS Officer's Signature Date (mm/dd/yyyy) I do [] do not [] concur with the USCIS officer's recommendation of the Form N-600K. USCIS Field Office Director's Signature Date (mm/dd/yyyy)	[page 12] Part 13. USCIS Officer Report and Recommendation [No Change] 1. True and correct; 2. The applicant derived or acquired U.S. citizenship on (mm/dd/yyyy) 3. The applicant derived or acquired U.S. citizenship through (Select the box next to the appropriate section of law or, if the section of law is not reflected, type or print the applicable section of law in the space next to “Other.”) INA Section 322(a)(2)(A) of the (Parent residence); INA Section 322(a)(2)(B) of the (Grandparent residence); or Other _____ I recommend that this Form N-600K be: Approved Denied Issue Certificate of Citizenship in the Name of Family Name (Last Name) Given Name (First Name) Middle Name USCIS Officer's Printed Name USCIS Officer’s Title USCIS Officer's Signature Date of Signature (mm/dd/yyyy) [No Change] USCIS Field Office Director's Signature Date of Signature (mm/dd/yyyy)

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