Form N-600 Application for Certificate of Citizenship

Application for Certificate of Citizenship

USCIS
Form N-600

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

Date Stamp

For
USCIS
Use
Only

OMB No. 1615-0057
Expires 02/28/2017
Action Block

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Remarks

To be completed
by an Attorney
or 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.

Enter Your 9 Digit A-Number:

Part 1. Information About Your Eligibility
1.

► A-

This application is being filed based on the fact that: (Select only one box)
I am a BIOLOGICAL child of a U.S. citizen parent.

I am an ADOPTED child of a U.S. citizen parent.

Other (Explain fully):

NOTE: If you need extra space to complete this section, use the space provided in Part 11. Additional Information.

Part 2. Information About You

NOTE: Provide information about yourself if you are a person applying for the Certificate of Citizenship. Provide information
about your child if you are a U.S. citizen parent applying for a Certificate of Citizenship for your minor child.
1.

Current Legal Name (do not provide a nickname)
Family Name (Last Name)

2.

Given Name (First Name)

Your Name Exactly As It Appears on Your Permanent Resident Card (if different from above)
Family Name (Last Name)

3.

Given Name (First Name)

Middle Name

Other Names You Have Used Since Birth
Provide all other names you have ever used, include nicknames, maiden name, and aliases.
Family Name (Last Name)

4.

Middle Name

Given Name (First Name)

U.S. Social Security Number (if any)

5.

►
6.

Date of Birth (mm/dd/yyyy)

8.

Country of Prior Citizenship or Nationality

7.

USCIS Online Account Number (if any)
►

Country of Birth

9.

Gender
Male

Form N-600 02/13/17 N

Middle Name

Female
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Part 2. Information About You (continued)
10.

A-

Mailing Address
In Care Of Name (if any)

Street Number and Name

Apt. Ste. Flr. Number

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City or Town

State

-

Postal Code (foreign address only) Country (foreign address only)

Province (foreign address only)

11.

ZIP Code + 4

Physical Address

Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.) Apt. Ste. Flr. Number

City or Town

State

-

Postal Code (foreign address only) Country (foreign address only)

Province (foreign address only)

12.

ZIP Code + 4

Current Marital Status

Single, Never Married

Married

Divorced

Widowed

Separated

Marriage Annulled

Other (Explain):
13.

U.S. Armed Forces

Are you a member or veteran of any branch of the U.S. Armed Forces?
14.

Yes

No

Information About Your Admission into the United States and Current Immigration Status
A. I arrived in the following manner
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. I used the following travel document to be admitted to the United States
Passport
Passport Number

Travel Document
Travel Document Number

Country of Issuance for Passport or
Travel Document

Form N-600 02/13/17 N

Date Passport or Travel Document
Issued (mm/dd/yyyy)

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Part 2. Information About You (continued)

A-

C. I am
A Lawful Permanent Resident (LPR)

A Nonimmigrant

A Refugee/Asylee

Other (Explain):
NOTE: If you select “Other” and you need extra space to complete this section, use the space provided in Part 11.
Additional Information.

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D. I obtained LPR status through adjustment of status in the United States or admission as a LPR (if applicable)
Date I became a LPR
(mm/dd/yyyy)

15.

U.S. Citizenship and Immigration Services (USCIS) Office That Granted My LPR
Status or Location Where I Was Admitted

Have you previously applied for a Certificate of Citizenship or U.S. Passport?

Yes

No

If you answered "Yes" to Item Number 15., provide an explanation below. If you need extra space to complete this section, use
the space provided in Part 11. Additional Information.

16.

Have you ever abandoned or lost your LPR status?

Yes

No

If you answered "Yes" to Item Number 16., provide an explanation below. If you need extra space to complete this section, use
the space provided in Part 11. Additional Information.

17.

Were you adopted?

Yes

No

Yes

No

If you answered "Yes" to Item Number 17., complete Items A. - D.
A. Place of Final Adoption

18.

City or Town

State

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

C. Date Legal Custody Began
(mm/dd/yyyy)

Country

D. Date Physical Custody Began
(mm/dd/yyyy)

Did you have to be re-adopted in the United States?
If you answered "Yes" to Item Number 18., complete Items A. - D.
A. Place of Final Adoption
City or Town

B. Date of Final Adoption
(mm/dd/yyyy)

State

Country

C. Date Legal Custody Began
(mm/dd/yyyy)

D. Date Physical Custody Began
(mm/dd/yyyy)

19.

Were your parents married to each other when you were born (or adopted)?

Yes

No

20.

Did your parents marry after you were born?

Yes

No

21.

Do you regularly reside in the United States in the legal and physical custody of your U.S. citizen parents?

Yes

No

Form N-600 02/13/17 N

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Part 2. Information About You (continued)
22.

A-

Have you been absent from the United States since you first arrived?

Yes

No

Complete the following information only if you are claiming U.S. citizenship at the time of birth if you were born before
October 10, 1952. If you need extra space to complete this section, use the space provided in Part 11. Additional Information.
A. Date You Left the United States
(mm/dd/yyyy)

B. Date You Returned to the
United States (mm/dd/yyyy)

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C. Place of Entry Upon Return to the United States
City or Town

State

D. Date You Left the United States
(mm/dd/yyyy)

E. Date You Returned to the
United States (mm/dd/yyyy)

F. Place of Entry Upon Return to the United States
City or Town

State

Part 3. Biographic Information
1.

Ethnicity (Select only one box)
Hispanic or Latino

2.

Not Hispanic or Latino

Race (Select all applicable boxes)
White
Asian
Black or
African American

American Indian
or Alaska Native

3.

Height Feet

Pounds

5.

Eye color (Select only one box)
Black

6.

Inches

Blue

4.

Brown

Weight

Gray

Green

Hazel

Native Hawaiian or
Other Pacific Islander

Maroon

Pink

Unknown/
Other

Hair color (Select only one box)
Bald
(No hair)

Black

Blond

Brown

Gray

Red

Sandy

White

Unknown/
Other

Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father)
NOTE: Complete this section if you are claiming citizenship through a U.S. biological father (of adoptive father). Provide
information about yourself if you are a U.S. citizen father applying for a Certificate of Citizenship on behalf of your minor
biological or adopted child.
1.

Current Legal Name of U.S. Citizen Father
Family Name (Last Name)

Form N-600 02/13/17 N

Given Name (First Name)

Middle Name

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A-

Part 4. Information About Your U.S. Citizen Biological Father
(or Adoptive Father) (continued)
2.

Date of Birth (mm/dd/yyyy)

5.

Physical Address

3.

Country of Birth

4.

Country of Citizenship or Nationality

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Street Number and Name (Type or print "Deceased" and the date of death if your father has passed away.) Apt. Ste. Flr. Number

City or Town

State

-

Postal Code (foreign address only) Country (foreign address only)

Province (foreign address only)

6.

ZIP Code + 4

My father 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 any)
► A-

Naturalization

Place of Naturalization (Name of Court or USCIS Office Location)

City or Town

State

Certificate of Naturalization Number

A-Number (if any)

Date of Naturalization (mm/dd/yyyy)

► A-

7.

Has your father ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?

Yes

No

If you answered “Yes” to Item Number 7., provide an explanation in Part 11. Additional Information.
8.

Marital History
A. How many times has your U.S. citizen father been married (including annulled marriages and
marriages to the same person)?
B. What is your U.S. citizen father's current marital status?
Single, Never Married

Married

Divorced

Widowed

Separated

Marriage Annulled

Other (Explain):
If you selected "Other," provide an explanation. If you need extra space to complete this section, use the space provided in
Part 11. Additional Information.

Form N-600 02/13/17 N

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A-

Part 4. Information About Your U.S. Citizen Biological Father
(or Adoptive Father) (continued)
9.

Information About U.S. Citizen Father's Current Spouse
A. Family Name (Last Name)

Given Name (First Name)

Middle Name

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

C. Country of Birth

D. Country of Citizenship or Nationality

E. Spouse's Physical Address
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Postal Code
(foreign address only)

Province
(foreign address only)

ZIP Code + 4
-

Country
(foreign address only)

F. Date of Marriage (mm/dd/yyyy)

G. Place of Marriage
City or Town

State

Country

H. Spouse's Immigration Status
U.S. Citizen

Lawful Permanent Resident

Other (Explain):

If you selected "Other," provide an explanation. If you need extra space to complete this section, use the space provided in
Part 11. Additional Information.
I.

Is your U.S. citizen father's current spouse also your biological (or adopted) mother?

Yes

No

Part 5. Information About Your U.S. Citizen Biological Mother (or Adoptive Mother)
NOTE: Complete this section if you are claiming citizenship through a U.S. citizen biological mother (or adoptive mother). Provide
information about yourself if you are a U.S. citizen mother applying for a Certificate of Citizenship on behalf of your minor
biological or adopted child.
1.

Current Legal Name of U.S. Citizen Mother
Family Name (Last Name)

2.

Date of Birth (mm/dd/yyyy)

Form N-600 02/13/17 N

Given Name (First Name)

3.

Country of Birth

Middle Name

4.

Country of Citizenship or Nationality

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A-

Part 5. Information About Your U.S. Citizen Biological Mother
(or Adoptive Mother) (continued)
5.

Physical Address
Street Number and Name (Type or print "Deceased" and the date of death if your mother has passed away.) Apt. Ste. Flr. Number

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City or Town

State

-

Postal Code (foreign address only) Country (foreign address only)

Province (foreign address only)

6.

ZIP Code + 4

My mother 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 any)
► A-

Naturalization

Place of Naturalization (Name of Court or USCIS Office Location)

City or Town

State

Certificate of Naturalization Number

A-Number (if any)

Date of Naturalization (mm/dd/yyyy)

► A-

7.

Has your mother ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?

Yes

No

If you answered “Yes” to Item Number 7., provide an explanation in Part 11. Additional Information.
8.

Marital History

A. How many times has your U.S. citizen mother been married (including annulled marriages and
marriages to the same person)?
B. What is your U.S. citizen mother's current marital status?
Single, Never Married

Married

Divorced

Widowed

Separated

Marriage Annulled

Other (Explain):
If you selected “Other,” provide an explanation. If you need extra space to complete this section, use the space provided in
Part 11. Additional Information.
9.

Information About U.S. Citizen Mother's Current Spouse
A. Family Name (Last Name)

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

Form N-600 02/13/17 N

Given Name (First Name)

Middle Name

C. Country of Birth

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A-

Part 5. Information About Your U.S. Citizen Biological Mother
(or Adoptive Mother) (continued)
D. Country of Citizenship or Nationality

E. Spouse's Physical Address

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Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Postal Code
(foreign address only)

Province
(foreign address only)

ZIP Code + 4
-

Country
(foreign address only)

F. Date of Marriage (mm/dd/yyyy)

G. Place of Marriage
City or Town

State

Country

H. Spouse's Immigration Status
U.S. Citizen
Lawful Permanent Resident
Other

If you selected “Other,” provide an explanation. If you need extra space to complete this section, use the space provided in
Part 11. Additional Information.
I.

Is your U.S. citizen mother's current spouse also your biological (or adopted) father?

Yes

No

Part 6. Physical Presence in the United States From Birth Until Filing of Form N-600

NOTE: Only applicants born outside the United States claiming to have been born U.S. citizens are required to provide all the dates
when your U.S. citizen biological father or U.S. citizen biological mother resided in the United States. Include all dates from your
birth until the date you file your Form N-600.
1.

Indicate whether this information relates to your U.S. citizen father or mother
U.S. Citizen Father

2.

U.S. Citizen Mother

Physical Presence in the United States
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)

Form N-600 02/13/17 N

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Part 7. Information About Military Service of U. S. Citizen Parents

A-

NOTE: Complete this only if you are an applicant claiming U.S. citizenship at time of birth abroad.
1.

Has your U.S. citizen parent served in the U.S. Armed Forces?

2.

If you answered "Yes" to Item Number 1., which parent served in the U.S. Armed Forces?
U.S. Citizen Father

3.

No

U.S. Citizen Mother

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Dates of Service (mm/dd/yyyy) (If time of service fulfills any of the required physical presence, submit evidence of the service.)
A. From (mm/dd/yyyy)

4.

Yes

To (mm/dd/yyyy)

B. From (mm/dd/yyyy)

To (mm/dd/yyyy)

Type of Discharge
Honorable

Other than Honorable

Dishonorable

Part 8. Applicant's Statement, Contact Information, Certification, and Signature
NOTE: Read the Penalties section of the Form N-600 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.

2.

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
, a language in which I am fluent and I
understood everything.

Applicant's Statement Regarding the Preparer

At my request, the preparer named in Part 10.,
prepared this application for me based only upon information I provided or authorized.

,

Applicant's Contact Information
3.

Applicant's Daytime Telephone Number

5.

Applicant's Email Address (if any)

4.

Applicant's Mobile Telephone Number (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.

Form N-600 02/13/17 N

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A-

Part 8. Applicant's Statement, Contact Information, Certification,
and Signature (continued)

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

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3) All of this information was complete, true, and correct at the time of filing.

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.

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)

Interpreter's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr.

Number

City or Town

State

ZIP Code + 4
-

Province

Postal Code

Country

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

6.

Interpreter's Email Address (if any)

Form N-600 02/13/17 N

5.

Interpreter's Mobile Telephone Number (if any)

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A-

Part 9. Interpreter's Contact Information, Certification, and Signature
(continued)
Interpreter's Certification
I certify, under penalty of perjury, that:

, which is the same language specified in Part 8.,
I am fluent in English and
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.

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Interpreter's Signature
7.

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

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)

Preparer's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr.

Number

City or Town

State

ZIP Code + 4
-

Province

Postal Code

Country

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

6.

Preparer's Email Address (if any)

Form N-600 02/13/17 N

5.

Preparer's Mobile Telephone Number (if any)

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Part 10. Contact Information. Declaration, and Signature of the Person
Preparing this Application, if Other Than the Applicant (continued)

A-

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.

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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.

Preparer's Certification

By my signature, I certify, under 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

Form N-600 02/13/17 N

Date of Signature (mm/dd/yyyy)

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Part 11. Additional Information

A-

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, you may make copies of this page to complete and file with this application or attach a separate sheet of paper.
Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item
Number to which your answer refers; and sign and date each sheet.
1.

Family Name (Last Name)

2.

A-Number (if any) ► A-

3.

A. Page Number

D.

4.

5.

A. Page Number

D.

6.

Middle Name

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A. Page Number

D.

Given Name (First Name)

A. Page Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

D.

Form N-600 02/13/17 N

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NOTE: Do not complete Parts 12. and 13. unless the USCIS officer instructs you to do so at the interview.
Part 12. Affidavit (do NOT complete this part unless instructed to do so
AT THE INTERVIEW)

A-

I, the (applicant, parent, or 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.

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Date of Signature (mm/dd/yyyy)

Applicant's, Parent's, or Legal Guardian's Signature

Subscribed and sworn or affirmed before me upon examination of the applicant (parent, legal, guardian) on
at

Date (mm/dd/yyyy)

.

(Location)

USCIS Officer's Printed Name

USCIS Officer's Title

USCIS Officer's Signature

Date of Signature (mm/dd/yyyy)

Part 13. Officer Report and Recommendation on Application for Certificate of Citizenship
(for USCIS use ONLY)

On the basis of the documents, records, 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:
1.

True and correct

2.

The applicant derived or acquired U.S. citizenship on

Date (mm/dd/yyyy)

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.”)

3.

4.

A.

INA Section 301

B.

INA Section 309

C.

INA Section 320

D.

INA Section 321

E.

Other
The applicant has not been expatriated since that time

Form N-600 02/13/17 N

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Part 13. Officer Report and Recommendation on Application for
Certificate of Citizenship (for USCIS use ONLY) (continued)
I recommend that this Form N-600 be:

Approved

A-

Denied

Issue Certificate of Citizenship in the name of
Family Name (Last Name)

Given Name (First Name)

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USCIS Officer's Printed Name

USCIS Officer's Title

USCIS Officer's Signature

I do

Middle Name

Date of Signature (mm/dd/yyyy)

do not concur with the USCIS Officer's recommendation of Form N-600.

USCIS District Director's or Field Office Director's Signature

Form N-600 02/13/17 N

Date of Signature (mm/dd/yyyy)

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