Form N-400 Application for Naturalization

Form N-400 09/13/13 N
For
USCIS
Use
Only
Other (explain): 5.
Are applying on the basis oI qualiIying military service. 4.
3.
Have been a Permanent Resident oI the United States Ior at least 3 years. In addition, you have been married to and living
with the same U.S. citizen spouse Ior the last 3 years, and your spouse has been a U.S. citizen Ior the last 3 years at the time
oI Iiling your Form N-400.
2.
Have been a Permanent Resident oI the United States Ior at least 5 years. 1.
You are at least 18 years old and
Part 1. Information About Your Eligibility (Check onlv one box or vour
Form N-400 mav be delaved)
Enter Your 9 Digit A-Number:
Date Stamp
Remarks
Your Current Legal Name ("# $#% provide a nickname)
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
1.
Part 2. Information About You (Person applving for naturali:ation)
Family Name (Last Name) Given Name (First Name)
Your Name Exactly As It Appears on Your Permanent Resident Card (if applicable) 2.
Middle Name (if applicable) Given Name (First Name) Family Name (Last Name)
Other Name(s) You Have Used Since Birth (include nicknames, aliases, and maiden name if applicable) 3.
Are a Permanent Resident oI the United States, and you are the spouse oI a U.S. citizen, and your U.S. citizen spouse is
regularly engaged in speciIied employment abroad. (Section 319(b) of the Immigration and Nationalitv Act)
Middle Name (if applicable)
Type or print all your answers in black ink. Type or print "N/A" iI an item is not applicable or the answer is "none" unless
otherwise indicated. Failure to answer all oI the questions may delay USCIS processing your Form N-400. NOTE: You must
complete Parts 1. - 14.
A-
Action Block Receipt
Page 1 oI 21
Application For Naturalization
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form N-400
OMB No. 1615-0052
Expires 09/30/2015
Form N-400 09/13/13 N
Part 2. Information About You (continued)
If Yes," print the new name vou would like to use in the space below.
No Yes Would you like to legally change your name?
Read the Form N-400 Instructions before you decide whether or not you would like to legally change your name.
Name Change (optional) 4.
Date You Became a Permanent Resident
(mm/dd/vvvv)
7. 6. U.S. Social Security Number
(if applicable)
5.
Country of Citizenship or Nationality 9. Country of Birth 8.
Blind or low vision.
Use a wheelchair or other device that assists with mobility.
DeaI or hard oI hearing and need an interpreter who uses the Iollowing sign language (e.g., American Sign Language):
If "Yes," check the box(es) below that applies.
No Yes Are you requesting an accommodation(s) to the naturalization process because of a disability and/or
an impairment? (See Form N-400 Instructions for accommodation examples)
10.
Require another type oI accommodation. (explain):
No Yes Do you have a physical or developmental disability or mental impairment that prevents you from
demonstrating your knowledge and understanding of the English language and/or civics requirements
for naturalization?
11.
If "Yes," submit a completed Form N-648, Medical Certification for Disabilitv Exceptions, when vou file vour Form N-400.
12. Exemptions from the English Language Test
A. Are you 50 years oI age or older and have you lived in the United States as a Permanent Resident Ior
periods totaling at least 20 years at the time oI Iiling your Form N-400?
No Yes
B. Are you 55 years oI age or older and have you lived in the United States as a Permanent Resident Ior
periods totaling at least 15 years at the time oI Iiling your Form N-400?
No Yes
C. Are you 65 years oI age or older and have you lived in the United States as a Permanent Resident Ior
periods totaling at least 20 years at the time oI Iiling your Form N-400? (If vou meet this requirement,
vou will also be given a simplified version of the civics test.)
No Yes
A-
Date of Birth
(mm/dd/vvvv)

Page 2 oI 21
Form N-400 09/13/13 N
Part 3. Information to Contact You
E-mail Address (if anv)
Work Phone Number (if anv) Daytime Phone Number 1. Evening Phone Number
Mobile Phone Number (if anv) 5.
Part 4. Information About Your Residence
City State ZIP Code 4
Street Number and Name
Mailing Address (if different from the address above) A.
C/O ("In Care Of" Name, if applicable)
1.
Number Flr. Ste. Apt.
A-
( )
-
( )
-
( )
-
2. 3.
4.
( )
-
Postal Code (foreign address onlv) Country (foreign address onlv) Province or Region (foreign address onlv)
Page 3 oI 21
-
Province or Region (foreign address onlv)
City
ZIP Code 4 State County
From (mm/dd/vvvv) To (mm/dd/vvvv)

Postal Code (foreign address onlv) Country (foreign address onlv)
-
Where have you lived during the last 5 years? Begin with where you live now and then list every location where you have
lived during the last 5 years. If you need more space, use an additional sheet(s) of paper.
Date oI Residence
Form N-400 09/13/13 N
Part 4. Information About Your Residence (continued) A-
2.
Date oI Residence From (mm/dd/vvvv) To (mm/dd/vvvv)

City County State ZIP Code 4
-
ZIP Code 4 State County City
Street Number and Name Number Flr. Ste. Apt.
Date oI Residence From (mm/dd/vvvv) 3. To (mm/dd/vvvv)
Date oI Residence From (mm/dd/vvvv) 4. To (mm/dd/vvvv)
-
-
Page 4 oI 21
Form N-400 09/13/13 N
American Indian
or Alaska Native
Part 5. Information About Your Parents A-
Page 5 oI 21
If your biological or legally adoptive mother or father is a U.S. citizen by birth, or naturalized before you reached your 18th
birthday, you may already be a U.S. citizen. Visit the USCIS Web site at www.uscis.gov Ior Iurther inIormation on this topic
beIore you consider Iiling Form N-400.
No Yes 1. Were your parents married before your 18th birthday?
2. Is your mother a U.S. citizen? No Yes
If "Yes," complete the following information.
B. Mother's Country of Birth
Mother's Date of Birth (mm/dd/vvvv) C.
A. Current Legal Name of U.S. Citizen Mother
Mother's Middle Name (if applicable) Mother's Given Name (First Name) Mother's Family Name (Last Name)
Is your father a U.S. citizen? No Yes

A. Current Legal Name of U.S. Citizen Father
Father's Middle Name (if applicable) Father's Given Name (First Name) Father's Family Name (Last Name)
B. Father's Country of Birth C. Father's Date of Birth (mm/dd/vvvv)
3.
NOTE: USCIS requires you to complete the categories below to conduct background checks. (See Form N-400 Instructions for more
information)
Part 6. Information for Criminal Records Check
Height Feet Inches Gender
Race (Select one or more)
Male Female 1.
4.
2.
Native Hawaiian or
Other PaciIic Islander
If Yes," complete the information below.
Bald (No hair) Sandy Red White Gray Blonde Brown Black
Hair color 5.
Black or
AIrican American
Asian White
Not Hispanic or Latino Hispanic or Latino
Ethnicity (Select one) 3.
Form N-400 09/13/13 N
Part 6. Information for Criminal Records Check (continued) A-
Page 6 oI 21
List where you have worked or attended school full time or part time during the last 5 years. Provide information for the
complete time period. Include all military, police, and/or intelligence service. Begin by providing inIormation about your most
recent or current employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were
selI-employed, were unemployed, or have studied Ior the last 5 years. II you worked Ior yourselI, write "selI-employed." II you were
unemployed, write "unemployed." If you need more space, use an additional sheet(s) of paper to complete Part 7.
Number Flr. Ste. Apt. Street Number and Name
-
Employer or School Name 1.
Your Occupation Date From (mm/dd/vvvv) Date To (mm/dd/vvvv)
2. Employer or School Name


-
Part 7. Information About Your Employment and Schools You Attended
6.
Brown Blue Green Hazel Gray Black Pink Maroon Other
Eye color
Form N-400 09/13/13 N
A-
Page 7 oI 21
Part 7. Information About Your Employment and Schools You Attended
(continued)
3. Employer or School Name
ZIP Code 4 State City

-
List below all the trips oI 24 hours or longer that you have taken outside the United States during the last 5 years. 3.
No Yes
Yes No
No Yes
Yes No
No Yes
Date You Left the
United States
(mm/dd/vvvv)
Date You Returned
to the United States
(mm/dd/vvvv)
Did Trip Last 6
Months or More?
Yes No
Countries to
Which You Traveled
Total Days
Outside the
United States
How many trips oI 24 hours or longer have you taken outside the United States during the last 5 years?
trips
2.
How many total days (24 hours or longer) did you spend outside the United States during the last 5 years?
days
1.
Part 8. Time Outside the United States
Begin with your most recent trip and work backwards. If you need more space, use an additional sheet(s) of paper.
Form N-400 09/13/13 N
Part 9. Information About Your Marital History A-
Page 8 oI 21
What is your current marital status?
How many times have you been married (including annulled marriages and marriage(s) to the same person)?
If vou are single and have $&'&( been married, indicate "0" and go to )*(% +,-
If you are married now, provide the following information about your current spouse.
Legal Name of Current Spouse
B.
A.
1.
3.
4.
Divorced Single, never married Widowed Married Marriage annulled
Separated
2. If you are married, is your spouse a current member of the U.S. Armed Forces?
Previous Legal Name of Current Spouse
Other Names Used by Current Spouse (include nicknames, aliases, and maiden name, if applicable)
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
C.
No Yes
Country (foreign address onlv)
Province or Region (foreign address onlv) Postal Code (foreign address onlv)
F. Current Spouse's Present Home Address
Current Spouse's Present Employer G.
-
D. Current Spouse's Date of Birth Date You Entered into Marriage with Current Spouse E.
(mm/dd/vvvv) (mm/dd/vvvv)
5. Is your current spouse a U.S. citizen? No Yes
If Yes," answer .%&/ 01/2&( 3-
If No," go to .%&/ 01/2&( 4-
Form N-400 09/13/13 N
Part 9. Information About Your Marital History (continued) A-
Page 9 oI 21
Date your current spouse became a U.S. citizen B.
7. If your current spouse is not a U.S. citizen, complete the following information.
A. Current Spouse's Country of Citizenship or Nationality B. Current Spouse's A-Number (if applicable)
Current Spouse's Immigration Status C.
Other (explain): Permanent Resident
When did your current spouse become a U.S. citizen? A.
If your current spouse is a U.S. citizen, complete the following information. 6.
At birth Other - Complete the following information. - Go to .%&/ 01/2&( 5-
(mm/dd/vvvv)
A-
If your current spouse has had more than one previous marriage, use an additional sheet(s) of paper to provide the
information requested in Items A. - H. below for each marriage.
A.
B. Prior Spouse's Immigration Status
U.S. Citizen Permanent Resident Other (explain):
Middle Name (if applicable) Given Name (First Name) Prior Spouse's Family Name (Last Name)
C. Prior Spouse's Date of Birth Prior Spouse's Country of Birth D.
E. Prior Spouse's Country of Citizenship or Nationality
Date of Marriage with Prior Spouse F. Date Marriage Ended with Prior Spouse G.
H. How Marriage Ended with Prior Spouse
Annulled Divorced Spouse Deceased Other (explain):
(mm/dd/vvvv)
How many times has your current spouse been married 67$891"7$: *$$199&" /*((7*:&; *$" /*((7*:&6;<
%# %=& ;*/& >&(;#$<? II your current spouse has been married beIore, provide the Iollowing inIormation about
your current spouse's prior spouse.
8.
Form N-400 09/13/13 N
Part 9. Information About Your Marital History (continued) A-
Page 10 oI 21
II you were married beIore, provide the Iollowing inIormation about your prior spouse. If you have more than one previous
marriage, use an additional sheet(s) of paper to provide the information requested in Items A. - H. below for each
marriage.
9.
Other (explain): Spouse Deceased Divorced Annulled
A.
B. Your Prior Spouse's Immigration Status When Your Marriage Ended
U.S. Citizen Permanent Resident Other (explain):
Middle Name (if applicable) Given Name (First Name) Your Prior Spouse's Family Name (Last Name)
C. Your Prior Spouse's Date of Birth
F. G. Date of Marriage with Your Prior Spouse
H.
Date Marriage Ended with Your Prior Spouse
How Marriage Ended with Your Prior Spouse
(mm/dd/vvvv)
Your Prior Spouse's Country of Birth D.
Your Prior Spouse's Country of Citizenship or Nationality E.
Provide the Iollowing inIormation about all your children (sons and daughters) listed in Item Number 1., regardless of age.
Use an additional sheet(s) of paper to list any additional children.
2.
Indicate your total number of children. (All children should be indicated, including. A. Children who are alive,
missing, deceased, B. Children born in the United States or in other countries, C. Children under 18 vears of age
or older, D. Children who are currentlv married or unmarried, E. Children living with vou or elsewhere,
F. Current stepchildren, G. Legallv adopted children, *$" H. Children born when vou were not married.)
1.
Child's Current Legal Name A.1.
Child's A-Number (if applicable) A.2.
Child's Country of Birth A.4.
A- (mm/dd/vvvv)
Child's Date of Birth A.3.
Part 10. Information About Your Children
Form N-400 09/13/13 N
Part 10. Information About Your Children (continued) A-
Page 11 oI 21
Child's Current Legal Name B.1.
B.2.
Child's A-Number (if applicable)
A- (mm/dd/vvvv)
Child's Date of Birth B.3.
Child's Country of Birth B.4.
Child's Current Address A.5.
What is your child's relationship to you? (e.g., biological child, stepchild,
legallv adopted child)
A.6.
-
B.5.
B.6.
Child's Current Address
-
Form N-400 09/13/13 N
Part 10. Information About Your Children (continued) A-
Page 12 oI 21
Child's Country of Birth
A-
C.2. C.3.
C.4.
(mm/dd/vvvv)
Child's Date of Birth
Child's Current Address
C.5.
C.6.
-
D.1. Child's Current Legal Name
D.2.
D.4.
Child's Country of Birth
A-
D.5. Child's Current Address
D.6.
(mm/dd/vvvv)
Child's Date of Birth D.3.
-
Child's Current Legal Name
C.1.
Form N-400 09/13/13 N
Part 11. Additional Information A-
Page 13 oI 21
No Yes Have you ever registered to vote in any Federal, State, or local election in the United States? 2.
No Yes Have you ever claimed to be a U.S. citizen (in writing or anv other wav)? 1.
Answer Item Numbers 1. - 21. If you answer ?@&;? to any of these questions, include a written explanation on an additional
sheet(s) of paper and provide any evidence to support your answer.
Have you ever voted in any Federal, State, or local election in the United States? 3. No Yes
Do you now have, or did you ever have, a hereditary title or an order oI nobility in any Ioreign country?
Have you ever been declared legally incompetent, or been conIined to a mental institution?
4.
5.
6.
Yes
No
Yes No
Yes
No
Do you owe any overdue Federal, State, or local taxes?
7. Yes No Have you ever not Iiled a Federal, State, or local tax return since you became a Permanent Resident?
II "Yes," did you consider yourselI to be a "non-U.S. resident"?
A.
B. Yes No
8. No Yes Have you called yourselI a "non-U.S. resident" on a Federal, State, or local tax return since you became a
Permanent Resident?
Have you ever been a member oI, involved in, or in any way associated with, any organization,
association, Iund, Ioundation, party, club, society, or similar group in the United States or in any other
location in the world?
10.
A.
No Yes
9.
B. II "Yes," provide the inIormation below. If you need more space, attach the names of the other group(s) on an
additional sheet(s) of paper and provide any evidence to support your answer.
Name of Group Purpose of the Group Dates of Membership

Have you ever been a member oI, or in any way associated (either directlv or indirectlv) with:
The Communist Party?
Any other totalitarian party?
A terrorist organization?
A.
B.
C.
Yes
No Yes
No Yes
No
From
(mm/dd/vvvv)
To
(mm/dd/vvvv)
Form N-400 09/13/13 N
Part 11. Additional Information (continued) A-
Page 14 oI 21
Have you ever advocated (either directlv or indirectlv) the overthrow oI any government by Iorce or
violence?
13.
Yes No 11.
Between March 23, 1933 and May 8, 1945, did you work Ior or associate in any way (either directlv or
indirectlv) with:
The Nazi government oI Germany? Yes
No
Yes No
Yes
No
Any German, Nazi, or S.S. military unit, paramilitary unit, selI-deIense unit, vigilante unit, citizen unit,
police unit, government agency or oIIice, extermination camp, concentration camp, prisoner oI war
camp, prison, labor camp, or transit camp?
Any government in any area (1) occupied by, (2) allied with, or (3) established with the help oI the
Nazi government oI Germany?
A.
B.
C.
Were you ever involved in any way with any oI the Iollowing:
Genocide?
Torture?
Killing, or trying to kill, someone?
Badly hurting, or trying to hurt, a person on purpose?
Forcing, or trying to Iorce, someone to have any kind oI sexual contact or relations?
Not letting someone practice his or her religion?
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
A.
B.
C.
D.
E.
F.
14.
15.
No
Yes No
Yes
Were you ever a member oI, or did you ever serve in, help, or otherwise participate in, any oI the
Iollowing groups:
Military unit?
Paramilitary unit? (a group of people who act like a militarv group but are not part of the official
militarv)
No Yes Police unit?
SelI-deIense unit?
Vigilante unit? (a group of people who act like the police, but are not part of the official police)
Rebel group?
Guerrilla group? (a group of people who use weapons against or otherwise phvsicallv attack the
militarv, police, government, or other people)
Militia? (an armv of people, not part of the official militarv)
Insurgent organization? (a group that uses weapons and fights against a government)
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
A.
B.
C.
D.
E.
F.
G.
H.
I.
12. Have you ever persecuted (either directlv or indirectlv) any person because oI race, religion, national
origin, membership in a particular social group, or political opinion?
No Yes
Form N-400 09/13/13 N
Part 11. Additional Information (continued)
16.
A-
Page 15 oI 21
Were you ever a worker, volunteer, or soldier, or did you otherwise ever serve in any oI the Iollowing:
Labor camp? (a place where people are forced to work)
Detention Iacility? (a place where people are forced to stav)
Prison camp?
Prison or jail? No Yes
No Yes
No Yes
No Yes
Yes No Any other place where people were Iorced to stay? E.
D.
C.
B.
A.
17.
No
Yes No
Yes
II "Yes," when you were part oI this group, or when you helped this group, did you ever tell another
person that you would use a weapon against that person?
II "Yes," when you were part oI this group, or when you helped this group, did you ever use a weapon
against another person?
Were you ever a part oI any group, or did you ever help any group, unit, or organization that used a
weapon against any person, or threatened to do so?
No Yes
B.
A.
No
Yes No
Yes No
Yes
18. Did you ever sell, give, or provide weapons to any person, or help another person sell, give, or provide
weapons to any person?
II "Yes," did you know that this person was going to use the weapons against another person?
II "Yes," did you know that this person was going to sell or give the weapons to someone who was
going to use them against another person?
19.
B.
A.
Did you ever receive any type oI military, paramilitary (a group of people who act like a militarv group but
are not part of the official militarv), or weapons training?
No Yes
20. Did you ever recruit (ask), enlist (sign up), conscript (require), or use any person under age 15 to serve in
or help an armed Iorce or group?
No Yes
21. Did you ever use any person under age 15 to do anything that helped or supported people in combat? No Yes
22.
Have you ever been convicted oI a crime or oIIense? 25.
Have you ever been charged with committing, attempting to commit, or assisting in committing a crime or
oIIense?
24.
Have you ever been arrested, cited, or detained by any law enIorcement oIIicer (including anv and all
immigration officials or the U.S. Armed Forces) Ior any reason?
23.
Have you ever committed, assisted in committing, or attempted to commit, a crime or oIIense Ior which you
were not arrested?
No Yes
No Yes
No Yes
No Yes
If any of Item Numbers 22. - 28. apply to you, you must answer ?@&;? even if your records have been sealed, expunged, or
otherwise cleared. You must disclose this inIormation even iI anyone, including a judge, law enIorcement oIIicer, or attorney, told
you that it no longer constitutes a record or told you that you do not have to disclose the inIormation.
Have you ever been placed in an alternative sentencing or a rehabilitative program (e.g., diversion,
deferred prosecution, withheld adfudication, deferred adfudication)?
26.
No Yes
Form N-400 09/13/13 N
Part 11. Additional Information (continued) A-
27.
Page 16 oI 21
II "Yes," have you completed the probation or parole?
28.
Have you ever received a suspended sentence, been placed on probation, or been paroled? No Yes
No Yes
No Yes Have you ever been in jail or prison?
II "Yes," how long were you in jail or prison? Years Months Days
B.
A.
B.
A.
II you answered "Yes" to Item Numbers 23. - 28., complete the Iollowing table. If you need more space, use an additional
sheet(s) of paper and provide any evidence to support your answer. II you answered "No" to *99 Item Numbers 23. - 28.,
go to Item Number 30.
Why were you
arrested, cited,
detained, or charged?
Date arrested, cited,
detained, or
charged.
(mm/dd/vvvv)
Where were you arrested, cited,
detained, or charged?
(Citv, State, Countrv)
Outcome or disposition of the
arrest, citation, detention or
charge (no charges filed, charges
dismissed, fail, probation, etc.)
29.
Answer Item Numbers 30. - 46. If you answer ?@&;? to any of these questions, except Item Numbers 37. and 38., include a
written explanation on an additional sheet(s) of paper and provide any evidence to support your answer.
Have you ever: 30.
Been a habitual drunkard?
Been a prostitute, or procured anyone Ior prostitution?
Sold or smuggled controlled substances, illegal drugs, or narcotics?
Been married to more than one person at the same time?
Helped anyone to enter, or try to enter, the United States illegally?
Gambled illegally or received income Irom illegal gambling?
Failed to support your dependents or to pay alimony?
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
A.
B.
C.
D.
F.
G.
H.
No Yes Married someone in order to obtain an immigration beneIit? E.
No Yes Made any misrepresentation to obtain any public beneIit in the United States? I.
Form N-400 09/13/13 N
31.
32.
A-
33.
Have you ever given any U.S. Government oIIicial(s) any inIormation or documentation that was Ialse,
Iraudulent, or misleading?
35.
Yes No
34.
Have you ever lied to any U.S. Government oIIicial to gain entry or admission into the United States or to
gain immigration beneIits while in the United States?
Yes No
Have you ever been removed, excluded, or deported Irom the United States? No Yes
Have you ever been ordered removed, excluded, or deported Irom the United States? No Yes
Page 17 oI 21
Are removal, exclusion, rescission, or deportation proceedings (including administrativelv closed
proceedings) currently pending against you?
36.
No Yes
No Yes
Have you ever been placed in removal, exclusion, rescission, or deportation proceedings? No Yes
37. Have you ever served in the U.S. Armed Forces?
No Yes
40.
Are you currently a member oI the U.S. Armed Forces?
II you are currently a member oI the U.S. Armed Forces, are you scheduled to deploy overseas, including
to a vessel, within the next 3 months? (Refer to the Address Change section within the Form N-400
Instructions on how to notifv USCIS if vou learn of vour deplovment plans after vou file vour Form N-400.)
No Yes
39.
No Yes II you are currently a member oI the U.S. Armed Forces, are you currently stationed overseas?
38.
41.
42.
Have you ever been court-martialed, administratively separated, or disciplined, or have you received an
other than honorable discharge, while in the U.S. Armed Forces?
Yes No
Have you ever been discharged Irom training or service in the U.S. Armed Forces because you were an
alien?
Yes No
43. Have you ever leIt the United States to avoid being draIted in the U.S. Armed Forces? No Yes
44. Have you ever applied Ior any kind oI exemption Irom military service in the U.S. Armed Forces?
46.
No Yes
Have you ever deserted Irom the U.S. Armed Forces? No Yes
No Yes Are you a male who lived in the United States at any time between your 18th and 26th birthdays?
(This does not include living in the United States as a lawful nonimmigrant.)
Selective Service Number Date Registered (mm/dd/vvvv)
II "Yes," when did you register Ior the Selective Service? Provide the inIormation below.
45.
A.
B.
Form N-400 09/13/13 N

47.
A-
Answer Item Numbers 47. - 53. If you answer AA0#AA to any of these questions, include a written explanation on an additional
sheet(s) of paper and provide any evidence to support your answer.
Do you support the Constitution and Iorm oI government oI the United States?
Do you understand the Iull Oath oI Allegiance to the United States?
49.
No
Yes No
Yes
48.
Page 18 oI 21
II the law requires it, are you willing to bear arms on behalI oI the United States?
II the law requires it, are you willing to perIorm noncombatant services in the U.S. Armed Forces? 51.
Yes
No Yes
No
No Yes Are you willing to take the Iull Oath oI Allegiance to the United States?
50.
II the law requires it, are you willing to perIorm work oI national importance under civilian direction?
53.
Yes No
Part 12. Your Signature (USCIS will refect vour Form N-400 if it is not signed)
Your Statement
I certiIy, under penalty oI perjury under the laws oI the United States oI America, that this application, and the evidence submitted
with it, are all true and correct. I authorize the release oI any inIormation USCIS needs to determine my eligibility Ior naturalization.
Date (mm/dd/vvvv) Your Signature
NOTE: Answer the next question ONLY iI you answered "Yes" to Part 11., Item Number 4. oI Form N-400.
At your naturalization ceremony, are you willing to give up any inherited title(s) or order(s) oI nobility that
you have in a Ioreign country?
No Yes
52.
Part 13. Signature and Contact Information of the Person Who Prepared This Form, If Other Than the
Applicant
By my signature, I certiIy, swear or aIIirm, under penalty oI perjury, that I prepared this Iorm on behalI oI, at the request oI, and with
the express consent oI the applicant. I completed the Iorm based only on responses the applicant provided to me. AIter completing
the Iorm, I reviewed it and all oI the applicant's responses with the applicant, who agreed with every answer he or she provided Ior
each question on the Iorm and, when required, supplied additional inIormation to respond to a question on the Iorm.
II "Yes," but you did not register with the Selective Service System and you are:
1. Still under 26 years oI age, you must register beIore you apply Ior naturalization, and complete the Selective Service
inIormation above; OR
C.
Now 26 years oI age or older but you did not register with the Selective Service, you must attach a statement explaining
why you did not register, and a status inIormation letter Irom the Selective Service.
2.
Form N-400 09/13/13 N
Each and every question and instruction on this Iorm, as well as my answer to each question, has been read to me by the interpreter
named below in

Page 19 oI 21
Part 13. Signature and Contact Information of the Person Who Prepared
This Form, If Other Than the Applicant (continued)
Postal Code (foreign address onlv) Province or Region (foreign address onlv) Country (foreign address onlv)
Preparer's Daytime Phone Number Preparer's Firm or Organization Name (if applicable)
Preparer's Address
County
Preparer's Fax Number Preparer's E-mail Address
( )
-
( )
-
-
A-
Part 14. Statement of Applicants Who Used an Interpreter
NOTE: II you answered "Yes" to Part 2., Item Numbers 11. or 12. oI this Iorm and during the completion oI the Iorm used an
interpreter to interpret the questions on the Iorm, then you and your interpreter must complete this section.
Date (mm/dd/vvvv) Preparer's Signature
Preparer's Printed Name
Applicant's Statement
Date (mm/dd/vvvv) Your Signature
I understand each and every question and instruction on this Iorm, as translated to me by my interpreter, and have provided true and
correct responses in the language indicated above.
(language used)
, a language in which I am Iluent.
Form N-400 09/13/13 N
Part 15. Signature at Interview
I swear (affirm) and certiIy under penalty oI perjury under the laws oI the United States oI America that I know that the contents oI
this Form N-400, Application Ior Naturalization, subscribed by me, including corrections number 1 through , are true
and correct. The evidence submitted by me on numbered pages 1 through is true and correct.
Subscribed to and sworn to (affirmed) beIore me
USCIS Officer's Printed Name or Stamp Date (mm/dd/vvvv)
Applicant's Signature USCIS Officer's Signature
Page 20 oI 21
NOTE: Do not complete Parts 15., 16., and 17. until the USCIS Officer instructs you to do so at the
interview.
( )
-
Telephone Number
Part 14. Statement of Applicants Who Used an Interpreter (continued) A-
Interpreter's Printed Name
Date (mm/dd/vvvv) Interpreter's Signature
I Iurther certiIy that I have read each and every question and instruction on this Iorm, as well as the answer to each question, to this
applicant in the above-mentioned language, and the applicant has inIormed me that he or she has understood each and every
instruction and question on the Iorm, as well as the answer to each question.
I certiIy that I am Iluent in English and .
(language used)
Your Interpreter's Statement
Form N-400 09/13/13 N
Applicant's Signature
Applicant's Printed Name
that I will take this obligation Ireely, without any mental reservation or purpose oI evasion, so help me God.
that I will perIorm work oI national importance under civilian direction when required by the law; and
that I will perIorm noncombatant service in the Armed Forces oI the United States when required by the law;
that I will bear arms on behalI oI the United States when required by the law;
that I will bear true Iaith and allegiance to the same;
that I will support and deIend the Constitution and laws oI the United States oI America against all enemies, Ioreign and domestic;
I hereby declare on oath, that I absolutely and entirely renounce and abjure all allegiance and Iidelity to any Ioreign prince, potentate,
state, or sovereignty, oI whom or which I have heretoIore been a subject or citizen;
II your application is approved, you will be scheduled Ior a public oath ceremony at which time you will be required to take the
Iollowing Oath oI Allegiance immediately prior to becoming a naturalized citizen. By signing below you acknowledge your
willingness and ability to take this oath:
A-
Page 21 oI 21
Part 17. Oath of Allegiance
II you answered "Yes" to Part 11., Item Numbers 4. and 53., then you must aIIirm the Iollowing beIore a USCIS oIIicer:
I further renounce the title of which I have heretofore held; or
I further renounce the order of nobility of to which I have heretofore belonged.
Applicant's Signature Applicant's Printed Name
USCIS Officer's Signature USCIS Officer's Printed Name
(list title(s))
(list order of nobilitv)
Part 16. Renunciation of Foreign Titles

Form N-400 Application for Naturalization

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Form N-400 Application for Naturalization

Uploaded by

Copyright:

Available Formats

Form N-400 09/13/13 N

Is your father a U.S. citizen? No Yes

Form N-400 09/13/13 N

You might also like