Fillable N-400 Application for Naturalization

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N-400 Application for Naturalization

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Form N-400 12/23/16 N Page 1 of 20
For
USCIS
Use
Only
Other (Explain):
E.
Are applying on the basis of qualifying military service.
D.
C.
Have been a lawful permanent resident of the United States for at least 3 years. In addition, you have been married to
and living with the same U.S. citizen spouse for the last 3 years, and your spouse has been a U.S. citizen for the last
3 years at the time you filed your Form N-400.
B.
Have been a lawful permanent resident of the United States for at least 5 years.
A.
You are at least 18 years of age and:
Part 1. Information About Your Eligibility (Select only one box or your
Form N-400 may be delayed)
Enter Your 9 Digit A-Number:
Date Stamp
Remarks
Your Current Legal Name (do not provide a nickname)
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
1.
Part 2. Information About You (Person applying for naturalization)
Family Name (Last Name) Given Name (First Name)
Your Name Exactly As It Appears on Your Permanent Resident Card (if applicable)2.
Are a lawful permanent resident of the United States and you are the spouse of a U.S. citizen and your U.S. citizen
spouse is regularly engaged in specified employment abroad. (See the Immigration and Nationality Act (INA) section
319(b).) If your residential address is outside the United States and you are filing under Section 319(b), select the
USCIS Field Office from the list below where you would like to have your naturalization interview:
Middle Name (if applicable)
START HERE - Type or print in black ink. Type or print "N/A" if an item is not applicable or the answer is none, unless
otherwise indicated. Failure to answer all of the questions may delay U.S. Citizenship and Immigration Services (USCIS) processing
your Form N-400. NOTE: You must complete Parts 1. - 15.
►
A-
Action BlockReceipt
Application for Naturalization
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form N-400
OMB No. 1615-0052
Expires 03/31/2019
►
1.
If your biological or legal adoptive mother or father is a U.S. citizen by birth, or was naturalized before you reached your 18th
birthday, you may already be a U.S. citizen. Before you consider filing this application, please visit the USCIS Website at
www.uscis.gov for more information on this topic and to review the instructions for Form N-600, Application for Certificate of
Citizenship, and Form N-600K, Application for Citizenship and Issuance of Certificate Under Section 322.
NOTE: Are either of your parents a United States citizen? If you answer “Yes,” then complete Part 6. Information About Your
Parents as part of this application. If you answer “No,” then skip Part 6. and go to Part 7. Biographic Information.
Joan
Jane
SMITH
SMITH
Jane
Joan
1 2 3 4 5 6 7 8 9
Form N-400 12/23/16 N Page 2 of 20
Part 2. Information About You (Person applying for naturalization) (continued)
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
If you answered ''Yes," type or print the new name you would like to use in the spaces provided below.
NoYes
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 Lawful
Permanent Resident (mm/dd/yyyy)
9.8.
U.S. Social Security Number (if applicable)5.
Country of Citizenship or Nationality
11.
Country of Birth
10.
Date of Birth
(mm/dd/yyyy)
►
6. USCIS Online Account Number (if any)
Gender
Male Female
7.
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?
No
Yes
12.
If you answered "Yes," submit a completed Form N-648, Medical Certification for Disability Exceptions, when you file your
Form N-400.
13. Exemptions from the English Language Test
A. Are you 50 years of age or older and have you lived in the United States as a lawful permanent
resident for periods totaling at least 20 years at the time you file your Form N-400?
NoYes
B. Are you 55 years of age or older and have you lived in the United States as a lawful permanent
resident for periods totaling at least 15 years at the time you file your Form N-400?
NoYes
C. Are you 65 years of age or older and have you lived in the United States as a lawful permanent
resident for periods totaling at least 20 years at the time you file your Form N-400? (If you meet
this requirement, you will also be given a simplified version of the civics test.)
NoYes
A-
Part 3. Accommodations for Individuals With Disabilities and/or Impairments
I am deaf or hard of hearing and request the following accommodation. (If you are requesting a sign-language
interpreter, indicate for which language (for example, American Sign Language).)
If you answered "Yes," select any applicable box.
NoYesAre you requesting an accommodation because of your disabilities and/or impairments? 1.
I am blind or have low vision and request the following accommodation:
A.
B.
NOTE: Read the information in the Form N-400 Instructions before completing this part.
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
Other Names You Have Used Since Birth (include nicknames, aliases, and maiden name, if applicable)3.
►
09/05/2014
02/14/1975
Australia
Australia
1 2 3 4 5 6 7 8 9
Joan
Jane
DOALLY
Form N-400 12/23/16 N Page 3 of 20
A-
Part 4. Information to Contact You
Part 5. Information About Your Residence
1.
Province or Region
(foreign address only)
City or Town
Street Number and Name
ZIP Code + 4StateCounty
To (mm/dd/yyyy)
NumberFlr.Ste.Apt.
Country
(foreign address only)
-
Where have you lived during the last five years? Provide your most recent residence and then list every location where you
have lived during the last five years. If you need extra space, use additional sheets of paper.
From (mm/dd/yyyy)
A. Current Physical Address
Postal Code
(foreign address only)
Daytime Telephone Number
1.
Work Telephone Number (if any)
2.
Evening Telephone Number
3.
Mobile Telephone Number (if any)
4.
Email Address (if any)5.
City or Town
State ZIP Code + 4
Street Number and Name
B.
In Care Of Name (if any)
NumberFlr.Ste.Apt.
Postal Code
(foreign address only)
Province or Region
(foreign address only)
-
Country
(foreign address only)
Current Mailing Address (if different from the address above)
Dates of
Residence
County
I have another type of disability and/or impairment (for example, use a wheelchair). (Describe the nature of your
disability and/or impairment and the accommodation you are requesting.)
C.
Part 3. Accommodations for Individuals With Disabilities and/or
Impairments (continued)
1 2 3 4 5 6 7 8 9
Vail
183 Gore Creek Street
81658
CO
Eagle
02/15/2014
Present
1111
USA
2223334444
3334445555
2223334444
4445556666
email@gmail.com
Form N-400 12/23/16 N Page 4 of 20
A-
Part 5. Information About Your Residence (continued)
Street Number and Name
From (mm/dd/yyyy) To (mm/dd/yyyy)
NumberFlr.Ste.Apt.
City or Town County State ZIP Code + 4
-
Postal Code
(foreign address only)
Province or Region
(foreign address only)
Physical Address 2C.
Country
(foreign address only)
Street Number and Name
From (mm/dd/yyyy) To (mm/dd/yyyy)
NumberFlr.Ste.Apt.
City or Town County State ZIP Code + 4
-
Postal Code
(foreign address only)
Province or Region
(foreign address only)
Physical Address 3D.
Country
(foreign address only)
Street Number and Name
Dates of
Residence
From (mm/dd/yyyy) To (mm/dd/yyyy)
NumberFlr.Ste.Apt.
City or Town County State ZIP Code + 4
-
Postal Code
(foreign address only)
Province or Region
(foreign address only)
Physical Address 4 E.
Country
(foreign address only)
Part 6. Information About Your Parents
2. Is your mother a U.S. citizen? NoYes
If you answered "Yes," complete the following information. If you answered "No," go to Item Number 3.
Information About Your Mother
NoYes
1. Were your parents married before your 18th birthday?
Dates of
Residence
Dates of
Residence
If neither one of your parents is a United States citizen, then skip this part and go to Part 7.
1 2 3 4 5 6 7 8 9
35 Chamberlain Street
09/22/2009
02/14/2014
Sydney
12345
NSW
Australia
N/A
N/A
Form N-400 12/23/16 N Page 5 of 20
A-
B. Mother's Country of Birth Mother's Date of Birth (mm/dd/yyyy)C.
Date Mother Became a U.S. Citizen
(if known) (mm/dd/yyyy)
D. E. Mother's A-Number
(if any)
►
A-
Part 6. Information About Your Parents (continued)
NoYes
A.
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
B. Father's Country of Birth C.
Father's Date of Birth (mm/dd/yyyy)
3.
If you answered ''Yes," complete the information below. If you answered "No," go to Part 7.
Date Father Became a U.S. Citizen
(if known) (mm/dd/yyyy)
D. E. Father's A-Number
(if any)
►
A-
Information About Your Father
Is your father a U.S. citizen?
Current Legal Name of U.S. Citizen Father
American Indian
or Alaska Native
NOTE: USCIS requires you to complete the categories below to conduct background checks. (See the Form N-400 Instructions for
more information.)
Part 7. Biographic Information
Height Feet Inches
Race (Select all applicable boxes)2.
3.
Native Hawaiian or
Other Pacific Islander
Black or
African American
AsianWhite
Not Hispanic or LatinoHispanic or Latino
Ethnicity (Select only one box)
1.
4. Weight Pounds
5.
BrownBlue Green HazelGrayBlack PinkMaroon
Unknown/
Other
Eye color (Select only one box)
Bald
(No hair)
SandyRed WhiteGrayBlond BrownBlack
Hair color (Select only one box)
6.
Unknown/
Other
A. Current Legal Name of U.S. Citizen Mother
Middle Name (if applicable)
Given Name (First Name)Family Name (Last Name)
1 2 3 4 5 6 7 8 9
5
7
1
2
5
Form N-400 12/23/16 N Page 6 of 20
A-
List where you have worked or attended school full time or part time during the last five years. Provide information for the complete time
period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current
employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were
unemployed, or have studied for the last five years. If you worked for yourself, type or print "self-employed." If you were unemployed,
type or print "unemployed." If you need extra space, use additional sheets of paper.
City or Town State ZIP Code + 4
NumberFlr.Ste.Apt.Street Number and Name
-
Employer or School Name 1.
Your Occupation Date From (mm/dd/yyyy)
Date To (mm/dd/yyyy)
2. Employer or School Name
City or Town State ZIP Code + 4
Street Number and Name NumberFlr.
Ste.Apt.
-
Postal Code
(foreign address only)
Province or Region
(foreign address only)
Postal Code
(foreign address only)
Province or Region
(foreign address only)
Part 8. Information About Your Employment and Schools You Attended
Country
(foreign address only)
Your Occupation Date From (mm/dd/yyyy) Date To (mm/dd/yyyy)
Country
(foreign address only)
3. Employer or School Name
Street Number and Name NumberFlr.Ste.Apt.
ZIP Code + 4StateCity or Town
Your Occupation Date From (mm/dd/yyyy) Date To (mm/dd/yyyy)
-
Postal Code
(foreign address only)
Province or Region
(foreign address only)
Country
(foreign address only)
1 2 3 4 5 6 7 8 9
Vail
CO
81658
Beta Corporation
10/12/2014
PRESENT
Management and Administration
Alpha Company
Sydney
222 West Way Drive
12345
NSW
USA
02/22/2009
02/14/2014
Management and Administration
Australia
N/A
Form N-400 12/23/16 N Page 7 of 20
A-
List below all the trips of 24 hours or longer that you have taken outside the United States during the last 5 years. Start with
your most recent trip and work backwards. If you need extra space, use additional sheets of paper.
3.
NoYes
Yes No
NoYes
Yes No
NoYes
Date You Left the
United States
(mm/dd/yyyy)
Date You Returned
to the United States
(mm/dd/yyyy)
Did Trip Last
6 Months or
More?
Yes No
Countries to
Which You
Traveled
Total Days
Outside the
United States
How many trips of 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 9. Time Outside the United States
What is your current marital status?
How many times have you been married (including annulled marriages, marriages to other people, and
marriages to the same person)?
If you are married now, provide the following information about your current spouse.
Current Spouse's Legal Name
B.
A.
1.
3.
4.
Divorced
Single, Never Married
WidowedMarried Marriage Annulled
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
Separated
2. If you are married, is your spouse a current member of the U.S. armed forces?
Current Spouse's Previous Legal Name
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
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.
NoYes
Part 10. Information About Your Marital History
D. Current Spouse's Date of Birth
(mm/dd/yyyy)
Date You Entered into Marriage
with Current Spouse (mm/dd/yyyy)
E.
If you are single and have never married, go to Part 11.
1 2 3 4 5 6 7 8 9
10/14/2015
12
Australia
04/10/2016
04/22/20156
10/02/2015
Australia
12
2
24
1
Jerry
John
SMITH
N-A
N-A
11/21/1975
03/15/2014
Form N-400 12/23/16 N Page 8 of 20
Part 10. Information About Your Marital History (continued)
A-
Street Number and Name
Province or Region
(foreign address only)
Postal Code
(foreign address only)
ZIP Code + 4StateCountyCity or Town
F. Current Spouse's Present Home Address
Current Spouse's Current Employer or CompanyG.
NumberFlr.Ste.Apt.
-
5. Is your current spouse a U.S. citizen?
No
Yes
If you answered ''Yes," answer Item Number 6. If you answered ''No," go to Item Number 7.
Country
(foreign address only)
Date Your Current Spouse Became
a U.S. Citizen (mm/dd/yyyy)
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 any)
Current Spouse's Immigration StatusC.
Other (Explain):Lawful 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 Item Number 8.
►
A-
A.
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
How many times has your current spouse been married (including annulled marriages, marriages to
other people, and marriages to the same person)? If your current spouse has been married before,
provide the following information about your current spouse's prior spouse.
8.
Legal Name of My Current Spouse's Prior Spouse
B. Immigration Status of My Current Spouse's Prior Spouse (if known)
U.S. Citizen Lawful Permanent Resident Other (Explain):
C. Date of Birth of My Current Spouse's
Prior Spouse (mm/dd/yyyy)
Country of Birth of My Current Spouse's
Prior Spouse
D.
Country of Citizenship or Nationality of My Current
Spouse's Prior Spouse
E.
If your current spouse has had more than one previous marriage, provide that information on additional sheets of paper.
1 2 3 4 5 6 7 8 9
183 Gore Creek Steer
81658
CO
Vail
Eagle
Charlie Corporation
1111
USA
N-A
1
Form N-400 12/23/16 N Page 9 of 20
Part 10. Information About Your Marital History (continued)
A-
My Current Spouse's Date of Marriage
with Prior Spouse (mm/dd/yyyy)
F. Date My Current Spouse's Marriage Ended
with Prior Spouse (mm/dd/yyyy)
G.
H. How My Current Spouse's Marriage Ended with Prior Spouse
Annulled Divorced Spouse Deceased Other (Explain):
If you were married before, provide the following information about your prior spouse. If you have more than one previous
marriage, provide that information on additional sheets of paper.
9.
Other (Explain):Spouse DeceasedDivorcedAnnulled
A.
B. My Prior Spouse's Immigration Status When My Marriage Ended (if known)
U.S. Citizen Lawful Permanent Resident
Other (Explain):
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
C. My Prior Spouse's Date of Birth
(mm/dd/yyyy)
F.
G.
Date of Marriage with My Prior
Spouse (mm/dd/yyyy)
H.
Date Marriage Ended with My
Prior Spouse (mm/dd/yyyy)
How Marriage Ended with My Prior Spouse
My Prior Spouse's Country
of Birth
D.
My Prior Spouse's Country of
Citizenship or Nationality
E.
My Prior Spouse's Legal Name
Indicate your total number of children. (You must indicate ALL children, including: children who are alive,
missing, or deceased; children born in the United States or in other countries; children under 18 years of age or
older; children who are currently married or unmarried; children living with you or elsewhere; current
stepchildren; legally adopted children; and children born when you were not married.)
1.
Part 11. Information About Your Children
Provide the following information about all your children (sons and daughters) listed in Item Number 1., regardless of age.
To list any additional children, use additional sheets of paper.
2.
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
Child 1 A.
Current Legal Name
A-Number (if any)
►
A-
Date of Birth (mm/dd/yyyy) Country of Birth
1 2 3 4 5 6 7 8 9
N-A
0
Form N-400 12/23/16 N Page 10 of 20
Part 11. Information About Your Children (continued)
A-
Child 2 B.
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
A-Number (if any)
►
A-
Date of Birth (mm/dd/yyyy)
Current Address
Street Number and Name
Province or Region
(foreign address only)
Postal Code
(foreign address only)
ZIP Code + 4StateCountyCity or Town
What is your child's relationship to you? (for example, biological child,
stepchild, legally adopted child)
NumberFlr.Ste.
Apt.
-
Current Address
Street Number and Name
Province or Region
(foreign address only)
Postal Code
(foreign address only)
ZIP Code + 4StateCountyCity or Town
NumberFlr.Ste.
Apt.
What is your child's relationship to you? (for example, biological child,
stepchild, legally adopted child)
-
Country
(foreign address only)
Country
(foreign address only)
Current Legal Name
Current Legal Name
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
C.
Country of Birth
Child 3
Country of Birth
A-Number (if any)
►
A-
Date of Birth (mm/dd/yyyy)
1 2 3 4 5 6 7 8 9
Form N-400 12/23/16 N Page 11 of 20
Part 11. Information About Your Children (continued)
A-
Current Address
Street Number and Name
Province or Region
(foreign address only)
Postal Code
(foreign address only)
ZIP Code + 4StateCountyCity or Town
NumberFlr.Ste.
Apt.
What is your child's relationship to you? (for example, biological child,
stepchild, legally adopted child)
-
Current Legal Name
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
A-Number (if any)
Country of Birth
►
A-
Current Address
Street Number and Name
Province or Region
(foreign address only)
Postal Code
(foreign address only)
ZIP Code + 4StateCountyCity or Town
NumberFlr.Ste.
Apt.
Date of Birth (mm/dd/yyyy)
What is your child's relationship to you? (for example, biological child,
stepchild, legally adopted child)
-
Country
(foreign address only)
Country
(foreign address only)
D. Child 4
Part 12. Additional Information About You (Person Applying for Naturalization)
NoYesHave you EVER registered to vote in any Federal, state, or local election in the United States?2.
NoYesHave you EVER claimed to be a U.S. citizen (in writing or any other way)?1.
Answer Item Numbers 1. - 21. If you answer "Yes" to any of these questions, include a typed or printed explanation on additional
sheets of paper.
Have you EVER voted in any Federal, state, or local election in the United States?3.
NoYes
4.
Yes NoDo you now have, or did you EVER have, a hereditary title or an order of nobility in any foreign
country?
If you answered "Yes," are you willing to give up any inherited titles or orders of nobility that you
have in a foreign country at your naturalization ceremony?
A.
B.
Yes No
Have you EVER been declared legally incompetent or been confined to a mental institution?5. NoYes
1 2 3 4 5 6 7 8 9
Form N-400 12/23/16 N Page 12 of 20
Part 12. Additional Information About You (Person Applying for
Naturalization) (continued)
A-
6. Yes NoDo you owe any overdue Federal, state, or local taxes?
7.
Yes NoHave you EVER not filed a Federal, state, or local tax return since you became a lawful permanent
resident?
If you answered "Yes," did you consider yourself to be a "non-U.S. resident"?
A.
B.
Yes No
8.
NoYesHave you called yourself a "non-U.S. resident" on a Federal, state, or local tax return since you became a
lawful permanent resident?
Have you EVER been a member of, involved in, or in any way associated with, any organization,
association, fund, foundation, party, club, society, or similar group in the United States or in any other
location in the world?
A.
NoYes
9.
B. If you answered "Yes," provide the information below. If you need extra space, attach the names of the other groups on
additional sheets of paper and provide any evidence to support your answers.
Name
of the
Group
Purpose
of the
Group
Dates of Membership
From
(mm/dd/yyyy)
To
(mm/dd/yyyy)
10. Have you EVER been a member of, or in any way associated (either directly or indirectly) with:
The Communist Party?
Any other totalitarian party?
A.
B.
Yes
NoYes
No
Have you EVER advocated (either directly or indirectly) the overthrow of any government by force or
violence?
13.
Yes No11.
Between March 23, 1933 and May 8, 1945, did you work for or associate in any way (either directly or
indirectly) with:
The Nazi government of Germany?
Yes
No
Yes No
Yes
No
Any government in any area occupied by, allied with, or established with the help of the Nazi
government of Germany?
A.
B.
C.
12. Have you EVER persecuted (either directly or indirectly) any person because of race, religion, national
origin, membership in a particular social group, or political opinion?
NoYes
A terrorist organization?C.
NoYes
Any German, Nazi, or S.S. military unit, paramilitary unit, self-defense unit, vigilante unit, citizen unit,
police unit, government agency or office, extermination camp, concentration camp, prisoner of war
camp, prison, labor camp, or transit camp?
1 2 3 4 5 6 7 8 9
Form N-400 12/23/16 N Page 13 of 20
Part 12. Additional Information About You (Person Applying for
Naturalization) (continued)
A-
Were you EVER involved in any way with any of the following:
Genocide?
Torture?
Killing, or trying to kill, someone?
Badly hurting, or trying to hurt, a person on purpose?
Forcing, or trying to force, someone to have any kind of 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 of, or did you EVER serve in, help, or otherwise participate in, any of the
following groups:
Military unit?
Paramilitary unit (a group of people who act like a military group but are not part of the official
military)?
NoYesPolice unit?
Self-defense unit? NoYes
A.
B.
C.
D.
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 physically attack the
military, police, government, or other people)?
Militia (an army of people, not part of the official military)?
Insurgent organization (a group that uses weapons and fights against a government)?
NoYes
No
Yes
No
Yes
No
Yes
No
Yes
E.
F.
G.
H.
I.
16. Were you EVER a worker, volunteer, or soldier, or did you otherwise EVER serve in any of the following:
Labor camp (a place where people are forced to work)?
Detention facility (a place where people are forced to stay)?
Prison camp?
Prison or jail?
No
Yes
No
Yes
No
Yes
NoYes
Yes NoAny other place where people were forced to stay?E.
D.
C.
B.
A.
17.
No
Yes No
Yes
If you answered "Yes," when you were part of this group, or when you helped this group, did you ever
use a weapon against another person?
Were you EVER a part of any group, or did you EVER help any group, unit, or organization that used a
weapon against any person, or threatened to do so?
NoYes
B.
A.
If you answered "Yes," when you were part of this group, or when you helped this group, did you ever
tell another person that you would use a weapon against that person?
No
Yes No
Yes No
Yes18. Did you EVER sell, give, or provide weapons to any person, or help another person sell, give, or provide
weapons to any person?
If you answered "Yes," did you know that this person was going to use the weapons against another
person?
If you answered "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?
B.
A.
1 2 3 4 5 6 7 8 9
Form N-400 12/23/16 N Page 14 of 20
A-
22.
Have you EVER been convicted of a crime or offense?25.
Have you EVER been charged with committing, attempting to commit, or assisting in committing a crime
or offense?
24.
Have you EVER been arrested, cited, or detained by any law enforcement officer (including any
immigration official or any official of the U.S. armed forces) for any reason?
23.
Have you EVER committed, assisted in committing, or attempted to commit, a crime or offense for which
you were NOT arrested?
NoYes
NoYes
NoYes
NoYes
If any of Item Numbers 22. - 28. apply to you, you must answer "Yes" even if your records have been sealed, expunged, or
otherwise cleared. You must disclose this information even if someone, including a judge, law enforcement officer, or attorney, told
you that it no longer constitutes a record or told you that you do not have to disclose the information.
Part 12. Additional Information About You (Person Applying for
Naturalization) (continued)
27.
If you answered "Yes," have you completed the probation or parole?
28.
Have you EVER received a suspended sentence, been placed on probation, or been paroled? NoYes
NoYes
NoYesHave you EVER been in jail or prison?
If you answered "Yes," how long were you in jail or prison? Years Months Days
B.
A.
B.
A.
If you answered "Yes" to any question in Item Numbers 23. - 28., then complete this table. If you need extra space, use
additional sheets of paper and provide any evidence to support your answers.
Why were you
arrested, cited,
detained, or
charged?
Date arrested, cited,
detained, or
charged.
(mm/dd/yyyy)
Where were you
arrested, cited, detained, or
charged? (City or Town,
State, Country)
Outcome or disposition of the
arrest, citation, detention, or
charge (no charges filed, charges
dismissed, jail, probation, etc.)
29.
NoYesHave you EVER been placed in an alternative sentencing or a rehabilitative program (for example,
diversion, deferred prosecution, withheld adjudication, deferred adjudication)?
26.
If you answered "No" to ALL questions in Item Numbers 23. - 28., then skip this item and go to Item Number 30.
19. Did you EVER receive any type of military, paramilitary (a group of people who act like a military group
but are not part of the official military), or weapons training?
NoYes
20. Did you EVER recruit (ask), enlist (sign up), conscript (require), or use any person under 15 years of age
to serve in or help an armed force or group?
NoYes
21. Did you EVER use any person under 15 years of age to do anything that helped or supported people in
combat?
NoYes
1 2 3 4 5 6 7 8 9
Form N-400 12/23/16 N Page 15 of 20
A-
Answer Item Numbers 30. - 46. If you answer "Yes" to any of these questions, except Item Numbers 37. and 38., include a typed or
printed explanation on additional sheets of paper and provide any evidence to support your answers.
Have you EVER:30.
Been a habitual drunkard?
Been a prostitute, or procured anyone for 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 from illegal gambling?
NoYes
NoYes
No
Yes
No
Yes
No
Yes
No
Yes
A.
B.
C.
D.
F.
G.
No
Yes
Married someone in order to obtain an immigration benefit?E.
Part 12. Additional Information About You (Person Applying for
Naturalization) (continued)
31.
32.
33.
Have you EVER given any U.S. Government officials any information or documentation that was false,
fraudulent, or misleading?
35.
Yes
No
34.
Have you EVER lied to any U.S. Government officials to gain entry or admission into the United States or
to gain immigration benefits while in the United States?
Yes
No
Have you EVER been removed, excluded, or deported from the United States?
NoYes
Have you EVER been ordered removed, excluded, or deported from the United States?
NoYes
Are removal, exclusion, rescission, or deportation proceedings (including administratively closed
proceedings) currently pending against you?
36.
NoYes
No
Yes
Have you EVER been placed in removal, exclusion, rescission, or deportation proceedings?
NoYes
37.
Have you EVER served in the U.S. armed forces?
Are you currently a member of the U.S. armed forces?
NoYes
38.
Failed to support your dependents or to pay alimony? No
Yes
H.
No
Yes
Made any misrepresentation to obtain any public benefit in the United States?I.
A.
If you answered "Yes," are you scheduled to deploy overseas, including to a vessel, within the next
three months? (Refer to the Address Change section in the Instructions on how to notify USCIS if
you learn of your deployment plans after you file your Form N-400.)
NoYesB.
If you answered "Yes," are you currently stationed overseas?
NoYesC.
39.
40.
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 from training or service in the U.S. armed forces because you were an
alien?
Yes No
41. Have you EVER left the United States to avoid being drafted in the U.S. armed forces?
NoYes
42. Have you EVER applied for any kind of exemption from military service in the U.S. armed forces?
NoYes
Have you EVER deserted from the U.S. armed forces?
NoYes43.
1 2 3 4 5 6 7 8 9
Form N-400 12/23/16 N Page 16 of 20
A-
44.
NoYesAre 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/yyyy)
If you answered "Yes," when did you register for the Selective Service? Provide the information below.
A.
B.
Part 12. Additional Information About You (Person Applying for
Naturalization) (continued)
45.
Answer Item Numbers 45. - 50. If you answer ''No'' to any of these questions, include a typed or printed explanation on additional
sheets of paper and provide any evidence to support your answers.
Do you support the Constitution and form of Government of the United States?
Do you understand the full Oath of Allegiance to the United States?
47.
No
Yes No
Yes
46.
If the law requires it, are you willing to bear arms on behalf of the United States?
If the law requires it, are you willing to perform noncombatant services in the U.S. armed forces? 49.
Yes
NoYes
No
No
Yes
Are you willing to take the full Oath of Allegiance to the United States?
48.
If the law requires it, are you willing to perform work of national importance under civilian direction?
Yes No50.
If you answered "Yes," but you did not register with the Selective Service System and you are:
1. Still under 26 years of age, you must register before you apply for naturalization, and complete the Selective Service
information above; OR
C.
Now 26 to 31 years of age (29 years of age if you are filing under INA section 319(a)), but you did not register with the
Selective Service, you must attach a statement explaining why you did not register, and provide a status information
letter from the Selective Service.
2.
Part 13. Applicant's Statement, Certification, and Signature
NOTE: Read the Penalties section of the Form N-400 Instructions before completing this part.
1.
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.
A.
Applicant's Statement Regarding the Interpreter
question in
The interpreter named in Part 14. read to me every question and instruction on this application and my answer to every
, a language in which I am fluent, and I understood everything.
B.
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
Applicant's Statement
Applicant's Statement Regarding the Preparer
At my request, the preparer named in Part 15., ,
prepared this application for me based only upon information I provided or authorized.
2.
1 2 3 4 5 6 7 8 9
Form N-400 12/23/16 N Page 17 of 20
A-
Part 13. Applicant's Statement, Certification, and Signature (continued)
Applicant's Certification
I understand that USCIS will require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or
signature) and, at that time, I will be required to sign an oath reaffirming that:
Applicant's Signature
Applicant's Signature Date of Signature (mm/dd/yyyy)3.
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.
Interpreter's Business or Organization Name (if any)2.
City or Town
State
Postal CodeProvince
Street Number and Name Apt. Flr. NumberSte.
Country
Interpreter's Mailing Address
3.
ZIP Code + 4
-
Interpreter's Given Name (First Name)Interpreter's Family Name (Last Name)1.
Provide the following information about the interpreter.
Interpreter's Full Name
Part 14. Interpreter's Contact Information, Certification, and Signature
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 that I seek.
I further authorize release of information contained in this application, in supporting documents, and in my USCIS records to other
entities and persons where necessary for the administration and enforcement of U.S. immigration laws.
I 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.
I reviewed and provided or authorized all of the information in my application;
I understood all of the information contained in, and submitted with, my application; and
All of this information was complete, true, and correct at the time of filing.
1)
2)
3)
1 2 3 4 5 6 7 8 9
Don't forget to sign!
09/17/2017
Form N-400 12/23/16 N Page 18 of 20
A-
Part 14. Interpreter's Contact Information, Certification, and Signature
(continued)
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
, which is the same language specified in Part 13., 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.
Date of Signature (mm/dd/yyyy)Interpreter's Signature
Interpreter's Signature
7.
Part 15. 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
Preparer's Given Name (First Name)Preparer's Family Name (Last Name)1.
Preparer's Business or Organization Name (if any)
2.
3. Street Number and Name Apt. Flr. NumberSte.
City or Town
State
Postal CodeProvince Country
Preparer's Mailing Address
ZIP Code + 4
-
Interpreter's Contact Information
4. Interpreter's Daytime Telephone Number
Interpreter's Email Address (if any)
5.
Interpreter's Mobile Telephone Number (if any)
6.
1 2 3 4 5 6 7 8 9
Don't forget to sign!
Form N-400 12/23/16 N Page 19 of 20
A-
Part 15. Contact Information, Declaration, and Signature of the Person
Preparing This Application, if Other Than the Applicant (continued)
Preparer's Contact Information
Preparer's Daytime Telephone Number Preparer's Mobile Telephone Number (if any)
Preparer's Email Address (if any)
4.
6.
5.
I am not an attorney or accredited representative but have prepared this application on behalf of
the applicant and with the applicant's consent.
I am an attorney or accredited representative and my representation of the applicant in this case
does not extend beyond the preparation of this application.
7.
Preparer's Statement
A.
B.
extends
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
Date of Signature (mm/dd/yyyy)
Preparer's Signature
8.
NOTE: Do not complete Parts 16., 17., or 18. until the USCIS Officer instructs you to do so at the
interview.
I swear (affirm) and certify under penalty of perjury under the laws of the United States of America that I know that the contents of
this Form N-400, Application for Naturalization, subscribed by me, including corrections number 1 through ____________, are
complete, true, and correct. The evidence submitted by me on numbered pages 1 through ________________ are complete, true, and
correct.
Part 16. Signature at Interview
Subscribed to and sworn to (affirmed) before me
USCIS Officer's Printed Name or Stamp Date of Signature (mm/dd/yyyy)
Applicant's Signature USCIS Officer's Signature
1 2 3 4 5 6 7 8 9
Don't forget to sign!
Form N-400 12/23/16 N Page 20 of 20
A-
If you answered "Yes" to Part 12., Items A. and B. in Item Number 4., then you must affirm the following before a USCIS officer:
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 SignatureApplicant's Printed Name
USCIS Officer's Signature
USCIS Officer's Printed Name
(list titles)
(list order of nobility)
Part 17. Renunciation of Foreign Titles
Date of Signature (mm/dd/yyyy)
that I take this obligation freely, without any mental reservation or purpose of evasion; so help me God.
that I will perform work of national importance under civilian direction when required by the law; and
that I will perform noncombatant service in the armed forces of the United States when required by the law;
Applicant's Signature
Applicant's Printed Name
Middle Name (if applicable)
Given Name (First Name)
Family Name (Last Name)
Date of Signature (mm/dd/yyyy)
that I will bear arms on behalf of the United States when required by the law;
that I will bear true faith and allegiance to the same;
that I will support and defend the Constitution and laws of the United States of America against all enemies, foreign, and domestic;
I hereby declare on oath, that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince, potentate,
state, or sovereignty, of whom or which I have heretofore been a subject or citizen;
If your application is approved, you will be scheduled for a public oath ceremony at which time you will be required to take the
following Oath of Allegiance immediately prior to becoming a naturalized citizen. By signing below you acknowledge your
willingness and ability to take this oath:
Part 18. Oath of Allegiance
1 2 3 4 5 6 7 8 9
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N-400 Application for Naturalization

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Completed 3 July 2020

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