Page 1,
Part 1. Information
About Your Eligibility
|
[Page 1]
START HERE - Type or print in
black ink.
Part 1. Information About Your
Eligibility
Enter Your 9-Digit A-Number:
1. 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.
[New]
[] Other (Explain fully): [Fillable
Field]
NOTE: If you need extra
space to complete this section, use the space provided in Part
11. Additional Information.
|
[Page 1]
START HERE - Type or print in
black ink.
Part 1. Information About Your
Eligibility
Enter Your 9-Digit A-Number:
[deleted]
1.
I am a:
[ ] child of a
U.S. citizen filing for a Certificate of Citizenship for myself.
[ ] U.S.
citizen parent or legal guardian filing for a Certificate of
Citizenship on behalf of a child.
For Item
Number 2., provide information
about yourself if you are an applicant applying for the
Certificate of Citizenship. Provide
information about your child if
you are a U.S. citizen parent or legal guardian applying for a
Certificate of Citizenship for your minor child.
2.
What is your relationship
to your U.S. citizen parent? (Read
the N-600 Instructions for more information.)
[]
The biological child of a U.S. citizen parent. (If the U.S.
citizen parent is your biological father, you will generally have
to establish that you were born in wedlock or legitimated.)
[] The adopted
child of a U.S. citizen parent.
[ ] The child
of a non-genetic gestational U.S. citizen parent (person who
carried and gave birth to the child) who is also your legal
parent.
[
] The child of a U.S. citizen parent who was married to your
genetic or gestational parent at the time of your birth (even if
no genetic or gestational relationship exists with the U.S.
citizen parent) and both of your parents are also your legal
parents.
[] Other (Explain fully): [Fillable
Field]
NOTE: If you need extra
space to complete this section, use the space provided in Part
11. Additional Information.
|
Pages 1-4,
Part 2. Information
About You
|
[Page 1]
Part 2. Information About You
NOTE: Provide information
about yourself if you are an applicant 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)
Given Name (First Name)
Middle Name
2. Your Name Exactly As It
Appears on Your Permanent Resident Card (if different from
above)
Family Name (Last Name)
Given Name (First Name)
Middle Name
3. 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)
Given Name (First Name)
Middle Name
Family Name (Last Name)
Given Name (First Name)
Middle Name
4.
U.S. Social Security Number (if any)
5. USCIS Online Account
Number (if any)
6. Date of Birth
(mm/dd/yyyy)
7. Country of Birth
8. Country of Prior
Citizenship or Nationality
9. Gender
Male
Female
[New]
[Page 2]
10. Mailing Address
In Care
Of Name (if any)
Street Number and Name
Apt. Ste. Flr.
Number
City or Town
State
ZIP Code + 4
Province (foreign address only)
Postal Code (foreign address only)
Country (foreign address only)
11. 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
Province (foreign address only)
Postal Code (foreign address only)
Country (foreign address only)
12. 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?
Yes
No
14.
Information About Your Admission into the United States and
Current Immigration Status
A. I arrived
in the following manner
Port-of-Entry
[Fillable field]
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
Date Passport or Travel
Document Issued (mm/dd/yyyy)
[Page 3]
C. My most
recent immigration status in the United States was:
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.
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)
U.S. Citizen and Immigration
Services (USCIS) Office That Granted my LPR Status or Location
Where I Was Admitted
[New]
15. Have you
previously applied for a Certificate of Citizenship or U.S.
Passport?
Yes
No
[New]
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.
[Fillable Field]
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.
[Fillable Field]
[Moved
from below]
17. Were you
adopted?
Yes
No
If you answered “Yes”
to Item Number 17., complete Items
A. - D.
A. Place of
Final Adoption
City or Town
State
Country
B. Date of
Adoption (mm/dd/yyyy)
C. Date
Legal Custody Began (mm/dd/yyyy)
D. Date
Physical Custody Began (mm/dd/yyyy)
18. Did you
have to be re-adopted in the United States?
Yes
No
[New]
If you answered “Yes”
to Item Number 18., complete Items
A. - D.
[New]
A. Place of
Final Adoption
City or Town
State
Country
B. Date of
Adoption (mm/dd/yyyy)
C. Date
Legal Custody Began (mm/dd/yyyy)
D. Date
Physical Custody Began (mm/dd/yyyy)
[New]
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 parent(s), or, if over 18 years of
age, did you regularly reside in the legal and physical custody of
your U.S. citizen parent(s) before turning 18 years of age?
Yes
No
[Page 4]
22. 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.
[Moved
from above]
A. Date You Left the United
States (mm/dd/yyyy)
B. Date You Returned to the
United States (mm/dd/yyyy)
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
|
[Page 1]
Part 2. Information About You
(Child of a U.S. Citizen)
Provide
information about yourself if you are an applicant applying for
the Certificate of Citizenship. Provide information about your
child if you are a U.S. citizen parent or
legal guardian applying for a Certificate of Citizenship
for your minor child.
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 Your Permanent Resident Card (if different from
above)
Family Name (Last Name)
Given Name (First Name)
Middle Name
3. 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)
Given Name (First Name)
Middle Name
Family Name (Last Name)
Given Name (First Name)
Middle Name
4. U.S. Social Security
Number (if any)
5. USCIS Online Account
Number (if any)
6. Date of Birth
(mm/dd/yyyy)
7. Country of Birth
8. Country of Prior
Citizenship or Nationality
9. Gender
Male
Female
10. Height
Feet__ Inches __
[Page 2]
11.
Current Mailing Address
In Care Of Name (if any)
Street Number and Name
Apt. Ste. Flr.
Number
City or Town
State
ZIP Code
Province
(foreign address only)
Postal Code (foreign address only)
Country (foreign address only)
12.
Current Physical
Address (if different from the address
above)
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
ZIP Code
Province (foreign address only)
Postal Code (foreign address only)
Country (foreign address only)
13.
Current Marital Status
Single, Never Married
Married
Divorced
Widowed
Separated
Marriage Annulled
Other
[Fillable field]
14. U.S.
Armed Forces
Are you a member or veteran of
any branch of the U.S. Armed Forces?
Yes
No
15.
Information About Your Admission into the United States and
Immigration Status
A. I arrived
in the following manner
Port-of-Entry
[Fillable field]
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
Date Passport or Travel
Document Issued (mm/dd/yyyy)
[Page 3]
C. Have
you ever been a lawful permanent resident (LPR)?
Yes
(Answer Item D. and
Item Number 16.)
No (Go to
Item Number 17.)
[Delete]
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)
U.S. Citizenship
and Immigration Services (USCIS) Office That Granted my LPR Status
or Location Where I Was Admitted
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.
[Fillable
Field]
17.
Have you previously applied for a Certificate
of Citizenship?
Yes
No
If you
answered "Yes" to
Item Number 17.,
provide an explanation
below. If you need extra space to complete your explanation, use
the space provided in
Part 11. Additional Information.
[Fillable
Field]
18.
Have you previously applied for a U.S. Passport?
Yes
No
If you answered "Yes"
to Item Number 18.,
provide an explanation below. If you need extra
space to complete your
explanation, use the space provided in
Part 11. Additional Information.
[Fillable Field]
[Delete]
19.
Do you regularly reside in the legal and physical custody of your
U.S. citizen parent(s), or, if over 18 years of age, did you
regularly reside in the legal and physical custody of your U.S.
citizen parent(s) before turning 18 years of age?
Yes
No
20.
Were you adopted?
Yes
No
If you answered “Yes”
to Item Number 20.,
complete Item Numbers
20.A.
– 20.E.
If you answered “No,”
go to Item Number 23.
A. Place of
Adoption
City or Town
State
Country
B. Date of
Adoption (mm/dd/yyyy)
C. Date
Legal Custody Began (mm/dd/yyyy)
D. Date
Physical Custody Began (mm/dd/yyyy)
[deleted]
E. Was
this adoption considered a full, final, and complete adoption?
Yes
No
If you answered “Yes”
to Item Number 20.E.
proceed to Item Number
21. If you answered
“No” to Item
Number 20.E., complete Item
Number 22.
21.
Did your state of residence recognize your foreign adoption decree
as full and final under that state’s adoption laws?
Yes
(Go to Part
3.)
No (Answer
Item Numbers 22.A-22.D.,
then go to Part 3.)
22.
Information About Re-Adoption
A. Place of
Re-Adoption
City or Town
State
Country
B. Date of
Adoption (mm/dd/yyyy)
C. Date
Legal Custody Began (mm/dd/yyyy)
D. Date
Physical Custody Began (mm/dd/yyyy)
If you
are not adopted, answer Item
Numbers 23. and
24.
23.
Were your parents married to each other when
you were born?
Yes
No
24.
Did your parents marry after you were born?
Yes
No
[Moved
up]
[Page 4]
[Moved
down]
Answer
Item Number 25. only
if you are claiming U.S. citizenship at the time of birth and
you were born before October 10, 1952.
Go to Part
3. if this does not
apply to you. If you need extra space to
complete this section, use the space provided in Part
11. Additional Information.
25.
Have you been absent from the United States
since you first arrived?
Yes
(Answer Item Numbers
25.A.-25.F.)
No
(Go to Part 3.)
A. Date You Left the United
States (mm/dd/yyyy)
B. Date You Returned to the
United States (mm/dd/yyyy)
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
|
Pages 4-6,
Part 4. Information
About Your U.S. Citizen Biological Father (or Adoptive Father)
|
[Page 4]
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
(or 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 a U.S. Citizen Father
Family Name (Last Name)
Given Name (First Name)
Middle Name
[Page 5]
2. Date of Birth
(mm/dd/yyyy)
[new]
3. Country of Birth
4. Country of Citizenship or
Nationality
5. Physical Address
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
ZIP Code + 4
Province (foreign address only)
Postal Code (foreign address only)
Country (foreign address only)
6. My father 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
(if any)
Alien Registration (A-Number) (if
any)
[] Naturalization
Place of Naturalization (Name of
Court or USCIS Office Location)
City or Town
State
Certificate of Naturalization Number
A-Number
Date of Naturalization (mm/dd/yyyy)
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.
[Page 6]
[Moved from
below]
9. Information About U.S.
Citizen Father's Current Spouse
A. Family Name (Last Name)
Given Name (First Name)
Middle Name
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
ZIP Code + 4
Province (foreign address only)
Postal Code (foreign address only)
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
|
[Page 4]
Part
3. Information About
Your U.S. Citizen Parent
NOTE: Provide
information about your U.S. citizen
parent. Provide information about
yourself if you are a U.S. citizen parent
applying for a Certificate of Citizenship on behalf of your
minor child.
1.
Current Legal Name of a U.S. Citizen Parent
Family Name (Last Name)
Given Name (First Name)
Middle Name
[Page 5]
2. Date of Birth
(mm/dd/yyyy)
3.
This Parent is My:
[] Mother
[] Father
4.
Country of Birth
[deleted]
5. Current
Physical Address
Street Number and Name (Type or
print "Deceased" and the date of death if applicable.)
Apt. Ste. Flr.
Number
City or Town
State
ZIP Code
Province (foreign address only)
Postal Code (foreign address only)
Country (foreign address only)
6. My parent
is a U.S. citizen by
[] Birth in the United States
[] Acquisition after birth through
naturalization of parent(s)
Certificate of
Citizenship Number (if any)
Alien
Registration (A-Number) (if any)
[] Birth abroad to U.S. citizen
parent(s)
Certificate of Citizenship Number
(if any)
Alien Registration (A-Number) (if
any)
[] Naturalization
Place of Naturalization (Name of
Court or USCIS Office Location)
City or Town
State
Certificate of Naturalization Number
A-Number
Date of Naturalization (mm/dd/yyyy)
7. Has your parent
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 parent been married
(including annulled marriages and marriages to the same person)?
B. What is your U.S. citizen
parent’s current marital
status?
Single, Never Married
Married
Divorced
Widowed
Separated
Marriage Annulled
Other
[Fillable field]
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.
[Page 6]
9.
If your U.S. citizen parent is married, is their current spouse
also your other parent?
Yes (Go to
Part 4.)
No
(Answer Item
Numbers 10.A.-10.H.)
10.
Information About U.S. Citizen Parent's
Current Spouse
A. Family Name (Last Name)
Given Name (First Name)
Middle Name
B. Date of Birth
(mm/dd/yyyy)
C. Country of Birth
D. Country of Citizenship or
Nationality
E. Spouse’s Current
Physical Address
Street Number and Name
Apt. Ste. Flr.
Number
City or Town
State
ZIP Code
Province (foreign address only)
Postal Code (foreign address only)
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.
[Moved above]
|
Pages 6-8,
Part 5. Information
About Your U.S. Citizen Biological Mother (or Adoptive Mother)
|
[Page 6]
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)
Given Name (First Name)
Middle Name
2. Date of Birth
(mm/dd/yyyy)
[new]
3. Country of Birth
4. Country of Citizenship or
Nationality
[Page 7]
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
City or Town
State
ZIP Code + 4
Province (foreign address only)
Postal Code (foreign address only)
Country (foreign address only)
[new]
6. My mother 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
(if any)
Alien Registration (A-Number) (if
any)
[] Naturalization
Place of Naturalization (Name of
Court or USCIS Office Location)
City or Town
State
Certificate of Naturalization Number
A-Number
Date of Naturalization (mm/dd/yyyy)
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.
[Moved
from below]
9. Information About U.S.
Citizen Mother’s Current Spouse
A. Family Name (Last Name)
Given Name (First Name)
Middle Name
B. Date of Birth
(mm/dd/yyyy)
C. Country of Birth
[Page 8]
D. Country of Citizenship or
Nationality
E. Spouse’s Physical
Address
Street Number and Name
Apt. Ste. Flr.
Number
City or Town
State
ZIP Code + 4
Province (foreign address only)
Postal Code (foreign address only)
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
mother’s current spouse also your biological (or adopted)
father?
Yes
No
|
[Page 6]
Part 4.
Information About Your Other Parent
[deleted]
1.
Current Legal Name of Other Parent
Family Name (Last Name)
Given Name (First Name)
Middle Name
2. Date of Birth
(mm/dd/yyyy)
3.
This Parent is My:
[] Mother
[] Father
4.
Country of Birth
5.
Country of Citizenship or Nationality
[Page 7]
6.
Current Physical Address
Street Number and Name (Type or
print “Deceased” and the date of death if applicable.)
Apt. Ste. Flr.
Number
City or Town
State
ZIP Code
Province (foreign address only)
Postal Code (foreign address only)
Country (foreign address only)
7.
Is your other parent a U.S. citizen?
Yes
(Go to Item Number 8.)
No (Go to Item
Number 9.)
8.
My other parent is a U.S. citizen by
[] Birth in the United States
[] Acquisition after birth through
naturalization of parent(s)
Certificate of
Citizenship Number (if any)
Alien
Registration (A-Number) (if any)
[] Birth abroad to U.S. citizen
parent(s)
Certificate of Citizenship Number
(if any)
Alien Registration (A-Number) (if
any)
[] Naturalization
Place of Naturalization (Name of
Court or USCIS Office Location)
City or Town
State
Certificate of Naturalization Number
Alien Registration (A-Number)
Date of Naturalization (mm/dd/yyyy)
9.
Has your other parent 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 9.,
provide an explanation in Part 11. Additional Information.
10.
Marital History
A. How many times has your
other parent been married (including
annulled marriages and marriages to the same person)?
B. What is your other
parent’s current marital status?
Single, Never Married
Married
Divorced
Widowed
Separated
Marriage Annulled
Other
[Fillable field]
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.
11.
If your parent identified in Part
4. is married, is their current
spouse your parent identified in Part
3.?
Yes (Go to
Part 5.)
No
(Answer Item Numbers 12.A.-12.H.)
12.
Information About Other Parent’s
Current Spouse
A. Family Name (Last Name)
Given Name (First Name)
Middle Name
B. Date of Birth
(mm/dd/yyyy)
C. Country of Birth
[Page 8]
D. Country of Citizenship or
Nationality
E. Spouse’s Current
Physical Address
Street Number and Name
Apt. Ste. Flr.
Number
City or Town
State
ZIP Code
Province (foreign address only)
Postal Code (foreign address only)
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.
[Moved above]
|
Pages 9-10,
Part 8. Applicant’s
Statement, Contact Information, Certification, and Signature
|
[Page 9]
Part 8. Applicant’s
Statement, Contact Information, Certification, and Signature
NOTE: Read the Penalties
section of the Form N-600 Instructions before completing this
section.
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 field], 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
and all of my records that USCIS may need to determine my
eligibility for the immigration benefit that I seek.
I
furthermore 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 law.
[Page
10]
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 as 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 (sign in ink)
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]
Part 8. Applicant’s,
Parent’s, or Legal Guardian’s Statement,
Contact Information, Certification, and Signature
NOTE: Read the Penalties
section of the Form N-600 Instructions before completing this
section.
Applicant’s,
Parent’s, or Legal Guardian’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,
Parent’s, or Legal Guardian’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,
Parent’s, or Legal Guardian’s
Statement Regarding the Preparer
At
my request, the preparer named in Part
10.,
[Fillable field], prepared this application for me based only upon
information I provided or authorized.
Applicant’s,
Parent’s, or Legal Guardian’s
Contact Information
3.
Daytime
Telephone Number
4.
Mobile
Telephone
Number (if any)
5.
Email
Address (if any)
Applicant’s,
Parent’s, or Legal Guardian’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
and all of my records that USCIS may need to determine my
eligibility for the immigration benefit that I seek.
I
furthermore 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 law.
[Page
10]
I
understand that USCIS may require me (the
applicant/child) to
appear for an appointment to take my biometrics
and,
that
if I am required to appear, 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 as 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,
Parent’s, or Legal Guardian’s
Signature
6.
Signature
(sign in ink)
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 10-11,
Part 9.
Interpreter’s Contact Information, Certification, and
Signature
|
[Page 10]
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
5.
Interpreter’s Mobile Telephone Number (if any)
6.
Interpreter’s Email Address (if any)
[Page
11]
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 10]
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
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)
[Page
11]
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
(or
their parent or legal guardian) in
the identified language every question and instruction on this
application and his or her answer to every question. The
applicant
(or their parent or legal guardian)
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)
|
Pages 11-12,
Part 10. Contact
Information, Declaration, and Signature of the Person Preparing
this Application, if Other Than the Applicant
|
[Page 11]
Part
10. Contact Information, Declaration, and Signature of the Person
Preparing this Application, if Other Than the Applicant
…
[Page
12]
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, you may need
to submit a completed Form G-28, Notice of Entry of Appearance as
Attorney or Accredited Representative, with this application.
Members of the Armed Forces applying outside the United States for
a Certificate of Citizenship under INA section 320 may file Form
G-28I, Notice of Entry of Appearance as Attorney In Matters
Outside the Geographical Confines of the United States with this
application, if applicable.
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 (sign in ink)
Date
of Signature (mm/dd/yyyy)
|
[Page 11]
Part
10. Contact Information, Declaration, and Signature of the Person
Preparing this Application, if Other Than the Applicant,
Parent, or Legal Guardian
…
[Page
12]
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
(or the consent of their parent or legal guardian).
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, you may need
to submit a completed Form G-28, Notice of Entry of Appearance as
Attorney or Accredited Representative, with this application.
Members of the Armed Forces applying outside the United States for
a Certificate of Citizenship under INA section 320 may file Form
G-28I, Notice of Entry of Appearance as Attorney In Matters
Outside the Geographical Confines of the United States with this
application, if applicable.
Preparer’s
Certification
By
my signature, I certify, under penalty of perjury, that I prepared
this application at the request of the applicant
(or their parent or legal guardian).
The applicant (or
their parent or legal guardian) 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 (or
their parent or legal guardian) provided
to me or authorized me to obtain or use.
Preparer’s
Signature
8.
Preparer’s Signature (sign in ink)
Date
of Signature (mm/dd/yyyy)
|
Page 14,
Part 12. Affidavit
(do NOT
complete this part unless instructed to do so AT
THE INTERVIEW)
|
[Page
14]
Part
12. Affidavit (do
NOT
complete this part unless instructed to do so AT
THE INTERVIEW)
I,
the (applicant, parent, or legal guardian) [Field] 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 [Field] to [Field] inclusive, that the same are true and
correct to the best of my knowledge, and that corrections number
[Field] to [Field] were made by me or at my request.
Applicant’s,
Parent’s, or Legal Guardian’s Signature (Sign in ink)
Date
of Signature (mm/dd/yyyy)
Subscribed
and sworn or affirmed before me upon examination of the applicant
(parent, or legal guardian) on [Date (mm/dd/yyyy)] at
[(Location)].
USCIS
Officer’s Printed Name
USCIS
Officer’s Title
USCIS
Officer’s Signature (Sign in ink)
Date
of Signature (mm/dd/yyyy)
|
[Page
14]
Part
12. Affidavit (Do
NOT
complete this part unless instructed to do so AT
THE INTERVIEW)
I,
the (applicant, parent, or legal guardian) [Field] 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 [Field] to [Field] inclusive, that the same are true and
correct to the best of my knowledge, and that corrections number
[Field] to [Field] were made by me or at my request.
Applicant’s,
Parent’s, or Legal Guardian’s Signature (Sign in ink)
Date
of Signature (mm/dd/yyyy)
Subscribed
and sworn or affirmed before me upon examination of the applicant,
parent,
or legal guardian
on [Date
(mm/dd/yyyy)] at [(Location)].
USCIS
Officer’s Printed Name
USCIS
Officer’s Title
USCIS
Officer’s Signature (Sign in ink)
Date
of Signature (mm/dd/yyyy)
|
Pages 14-15,
Part 13. Officer
Report and Recommendation on Application for Certificate of
Citizenship (for
USCIS use ONLY)
|
[Page
14]
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)]
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.”)
A.
INA Section 301
B.
INA Section 309
C.
INA Section 320
D.
INA Section 321
E.
Other
4.
The applicant has not been expatriated since that time
[Page
15]
I
recommend that this Form N-600 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 (Sign in ink)
Date
of Signature (mm/dd/yyyy)
|
[Page 14]
Part
13. Officer Report
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 (if
applicable),
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)]
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.”)
A.
INA Section 301
B.
INA Section 309
C.
INA Section 320
D.
Former
INA Section 321
E.
Other
4.
The applicant has not been expatriated since that time
[Page
15]
This
Form N-600 is:
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 (Sign in ink)
Date
of Signature (mm/dd/yyyy)
|