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N-426fillable (ILW.COM)

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Our authority for collecting the information requested on
this form is contained in Sections 328 and 329 of the
Immigration and Nationality Act of 1952 (8 U.S.C. 1439
and 1440).
Paperwork Reduction Act Notice.
OMB No. 1615-0053; Expires 08/31/08
Department of Homeland Security
U.S. Citizenship and Immigration Services
This collection of information is estimated to average 45
minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and
reviewing the collection of information.
Send comments regarding this burden estimate or any
other aspect of this collection of information, including
suggestions for reducing this burden to U.S. Citizenship
and Immigration Services, Regulatory Management
Division, 111 Massachusetts Avenue, N.W., 3rd Floor,
Suite 3008 Washington, D.C. 20529. Do not mail your
completed application to this address.
Form N-426 Instructions (Rev. 06/30/06)Y
NOTE: Please type or print in block letters with a ball-point pen, using black ink. Be sure this form and the complete
return address are legible. Do not leave any questions unanswered. When appropriate insert "none," "not applicable" or
"N/A."
The principal purpose of this form is to solicit
information to secure a duly authenticated certification of
honorable active duty service from the U.S. Government
Executive Department, under which you served or are
serving, to satisfy statutory requirements for
naturalization as a U.S. citizen.
If you are applying for naturalization under Sections 328
or 329 of the Immigration and Nationality Act, you
should submit this form and Form G-325B, Biographic
Information, with your Form N-400, Application for
Naturalization, to U.S. Citizenship and Immigration
Services (USCIS).
All or part of the information solicited may as a matter
of routine use be disclosed to courts exercising
naturalization jurisdiction and to other Federal, state,
local and foreign law enforcement and regulatory
agencies, the Department of Defense, including any
component thereof, Selective Service System,
Department of State, Department of the Treasury,
Central Intelligence Agency, Interpol and individuals
and organizations that process the application for
naturalization, or during the courses of investigation, to
elicit further information required by USCIS to carry
out its functions.
Information solicited that indicates a violation or
potential violation of law, whether civil, criminal or
regulatory in nature, may be referred as a routine use to
the appropriate agency, whether Federal, state, local or
foreign, charged with the responsibility of investigating,
enforcing or prosecuting such violations.
An agency may not conduct or sponsor an information
collection and a person is not required to respond to a
collection of information unless it displays a currently
valid OMB control number.
Failure to provide any or all of the solicited information
may delay the naturalization process or result in a failure
to locate military records or prove qualifying military
service.
Instructions
N-426, Request for Certification
of Military or Naval Service
(Please discard this sheet before submitting request. Submit in triplicate, that is, all six pages of the form.)
What Is the Purpose of This Form?
What Is Our Authority for
Collecting This Information?
Are you a Military Retiree or Fleet Reservist?
Yes
No
Date Entered
on Active Duty
Alien Registration Number
Date of Request
Name Used During Active Service (Last, First, Middle)
U.S. Social Security Number
Place of Birth
Date of Birth
Check Which
Service Number
During This Period
Enlisted
Officer
Check Which
Branch of Service
Reserve
N. Guard
Officer
Enlisted
Signature (Present Name)
Present Address (Number, Street, City, State and Zip Code)
Instructions to Certifying Officer.
U.S. Citizenship and Immigration Services
Return to:
Branch of Service
(Show also last organization, if known.)
Date Released
From Active Duty
Date Membership
Began
Form N-426 (Rev. 06/30/06)Y Page 1
OMB No. 1615-0053; Expires 08/31/08
N-426, Request for Certification
of Military or Naval Service
NOTE TO CERTIFYING OFFICER: For use in connection with my application for naturalization, please complete the certification of military
service on Pages 2, 4, and 6 of this form and furnish it to the office of U.S. Citizenship and Immigration Services (USCIS) shown in the address
block below. The information shown below is furnished to help locate and identify my military records. (Submit in triplicate, that is, all six
pages of this form.)
NOTE TO APPLICANT: Furnish as much information as possible. If you were issued a Report of Separation, DD Form 214, attach a
copy. Fill in the blanks only on Pages 1, 3 and 5 of this form. Please type or print clearly in black ink. All copies must be legible. Do not
use pencil. (Submit in triplicate, that is, all six pages of this form.)
Reserve or National Guard Service:
If none, check
Check Which
Persons who are serving or have served honorably under specified conditions in the armed forces of the United States, inclusive of the reserve
components of the armed forces of the United States, are granted certain exemptions from the general requirements for naturalization. The law
requires such service to be established by a duly authenticated copy of the records of the executive department having custody of the record of
service, showing whether the service man or woman served honorably in an active-duty status, reserve-duty status, or both, and whether each
separation from the service was under honorable conditions. For that purpose, the certified statement on Pages 2, 4 and 6 of this form, executed
under the seal of your department, is required and should cover not only the period(s) of service shown above, but any other periods of service
(active, reserve or both) rendered by the service man or woman.
Pages 2, 4 and 6 of this form should be completed, or the information called for furnished by separate letter, and the form and letter returned to the
office of U. S. Citizenship and Immigration Services at the address in the block immediately below.
Department of Homeland Security
U.S. Citizenship and Immigration Services
None
Service Number
During This Period
Date Membership
Ended
Please type
or print
complete
return
address.
Include zip
code.
For an effective records search, it is important that ALL periods of service be shown below. (Use blank sheet(s) if more space is needed.)
Active Service:
(the United States, American Samoa, Swains Island or the Panama Canal Zone)
Certification of Military or Naval Service.
Name as shown in records:
1. Entered Service at
2. On
3. Served to
4. Branch of
Service
Reserve or National Guard Service.
9. Ended
7. Check Which
Reserve
N. Guard
11. Statement Regarding Alienage. (Complete this item in ALL cases.)
Record shows this person was not discharged on account of alienage.
Record shows this person was discharged on account of alienage. Details:
Complete this block if subject is a "Lodge Act Enlistee"-64 Stat. 316 (Army). Subsequent to enlistment under the Lodge Act on
subject entered
via
pursuant to Military orders on
I CERTIFY that the information here given concerning the service of the person named on the face of this form is correct according to the records
of the
(Official Signature)
[ SEAL ]
Date
By
,
Name correctly shown on front of form.
Active Service.
8. Began
6. Branch of Service
12.
(Name of department or organization)
at the port of
Remarks. Use for continuation of any of the above items. You should also show in the space below any derogatory information in your
records relating to the person's character, loyalty to the United States, disciplinary actions, convictions or other matters concerning his or her
fitness for citizenship.
Applicant: Do not fill out this page.
State whether serving honorably. If separated, state
whether under honorable conditions. If other than
honorable, give full details. Always complete item
11.
State whether serving honorably. State if Selected Reserve
of the Ready Reserve. If separated, state whether under
honorable conditions. If other than honorable, give full
details. Always complete Item 11.
Lodge Act Enlistee.
5.
10.
Form N-426 (Rev. 06/30/06)Y Page 2
Are you a Military Retiree or Fleet Reservist?
Yes
No
Date Entered
on Active Duty
Alien Registration Number
Date of Request
Name Used During Active Service (Last, First, Middle)
U.S. Social Security Number
Place of Birth
Date of Birth
Check Which
Service Number
During This Period
Enlisted
Officer
Check Which
Branch of Service
Reserve
N. Guard
Officer
Enlisted
Signature (Present Name)
Present Address (Number, Street, City, State and Zip Code)
Instructions to Certifying Officer.
U.S. Citizenship and Immigration Services
Return to:
Branch of Service
(Show also last organization, if known.)
Date Released
From Active Duty
Date Membership
Began
OMB No. 1615-0053; Expires 08/31/08
N-426, Request for Certification
of Military or Naval Service
Reserve or National Guard Service:
If none, check
Check Which
Persons who are serving or have served honorably under specified conditions in the armed forces of the United States, inclusive of the reserve
components of the armed forces of the United States, are granted certain exemptions from the general requirements for naturalization. The law
requires such service to be established by a duly authenticated copy of the records of the executive department having custody of the record of
service, showing whether the service man or woman served honorably in an active-duty status, reserve-duty status, or both, and whether each
separation from the service was under honorable conditions. For that purpose, the certified statement on Pages 2, 4 and 6 of this form, executed
under the seal of your department, is required and should cover not only the period(s) of service shown above, but any other periods of service
(active, reserve or both) rendered by the service man or woman.
Pages 2, 4 and 6 of this form should be completed, or the information called for furnished by separate letter, and the form and letter returned to the
office of U. S. Citizenship and Immigration Services at the address in the block immediately below.
Department of Homeland Security
U.S. Citizenship and Immigration Services
None
Service Number
During This Period
Date Membership
Ended
Please type
or print
complete
return
address.
Include zip
code.
NOTE TO CERTIFYING OFFICER: For use in connection with my application for naturalization, please complete the certification of military
service on Pages 2, 4, and 6 of this form and furnish it to the office of U.S. Citizenship and Immigration Services (USCIS) shown in the address
block below. The information shown below is furnished to help locate and identify my military records. (Submit in triplicate, that is, all six
pages of this form.)
NOTE TO APPLICANT: Furnish as much information as possible. If you were issued a Report of Separation, DD Form 214, attach a
copy. Fill in the blanks only on Pages 1, 3 and 5 of this form. Please type or print clearly in black ink. All copies must be legible. Do not
use pencil. (Submit in triplicate, that is, all six pages of this form.)
Form N-426 (Rev. 06/30/06)Y Page 3
For an effective records search, it is important that ALL periods of service be shown below. (Use blank sheet(s) if more space is needed.)
Active Service:
(the United States, American Samoa, Swains Island or the Panama Canal Zone)
Certification of Military or Naval Service.
Name as shown in records:
1. Entered Service at
2. On
3. Served to
4. Branch of
Service
Reserve or National Guard Service.
9. Ended
7. Check Which
Reserve
N. Guard
11. Statement Regarding Alienage. (Complete this item in ALL cases.)
Record shows this person was not discharged on account of alienage.
Record shows this person was discharged on account of alienage. Details:
Complete this block if subject is a "Lodge Act Enlistee"-64 Stat. 316 (Army). Subsequent to enlistment under the Lodge Act on
subject entered
via
pursuant to Military orders on
I CERTIFY that the information here given concerning the service of the person named on the face of this form is correct according to the records
of the
(Official Signature)
[ SEAL ]
Date
By
,
Name correctly shown on front of form.
Active Service.
8. Began
6. Branch of Service
12.
(Name of department or organization)
at the port of
Remarks. Use for continuation of any of the above items. You should also show in the space below any derogatory information in your
records relating to the person's character, loyalty to the United States, disciplinary actions, convictions or other matters concerning his or her
fitness for citizenship.
Applicant: Do not fill out this page.
State whether serving honorably. If separated, state
whether under honorable conditions. If other than
honorable, give full details. Always complete item
11.
State whether serving honorably. State if Selected Reserve
of the Ready Reserve. If separated, state whether under
honorable conditions. If other than honorable, give full
details. Always complete Item 11.
Lodge Act Enlistee.
5.
10.
Form N-426 (Rev. 06/30/06)Y Page 4
Are you a Military Retiree or Fleet Reservist?
Yes
No
For an effective records search, it is important that ALL periods of service be shown below. (Use blank sheet(s) if more space is needed.)
Active Service:
Date Entered
on Active Duty
Alien Registration Nu mber
Date of Request
Name Used During Active Service (Last, First, Middle)
U.S. Social Security Number
Place of Birth
Date of Birth
Check Which
Service Number
During This Period
Enlisted
Officer
Check Which
Branch of Service
Reserve
N. Guard
Officer
Enlisted
Signature (Present Name)
Present Address (Number, Street, City, State and Zip Code)
Instructions to Certifying Officer.
U.S. Citizenship and Immigration Services
Return to:
Branch of Service
(Show also last organization, if known.)
Date Released
From Active Duty
Date Membership
Began
OMB No. 1615-0053; Expires 08/31/08
N-426, Request for Certification
of Military or Naval Service
Reserve or National Guard Service:
If none, check
Check Which
Persons who are serving or have served honorably under specified conditions in the armed forces of the United States, inclusive of the reserve
components of the armed forces of the United States, are granted certain exemptions from the general requirements for naturalization. The law
requires such service to be established by a duly authenticated copy of the records of the executive department having custody of the record of
service, showing whether the service man or woman served honorably in an active-duty status, reserve-duty status, or both, and whether each
separation from the service was under honorable conditions. For that purpose, the certified statement on Pages 2, 4, and 6 of this form, executed
under the seal of your department, is required and should cover not only the period(s) of service shown above, but any other periods of service
(active, reserve or both) rendered by the service man or woman.
Pages 2 ,4 and 6 of this form should be completed, or the information called for furnished by separate letter, and the form and letter returned to the
office of U. S. Citizenship and Immigration Services at the address in the block immediately below.
Department of Homeland Security
U.S. Citizenship and Immigration Services
None
Service Number
During This Period
Date Membership
Ended
Please type
or print
complete
return
address.
Include zip
code.
NOTE TO CERTIFYING OFFICER: For use in connection with my application for naturalization, please complete the certification of military
service on Pages 2, 4, and 6 of this form and furnish it to the office of U.S. Citizenship and Immigration Services (USCIS) shown in the address
block below. The information shown below is furnished to help locate and identify my military records. (Submit in triplicate, that is, all six pages
of this form.)
NOTE TO APPLICANT: Furnish as much information as possible. If you were issued a Report of Separation, DD Form 214, attach a
copy. Fill in the blanks only on Pages 1, 3 and 5 of this form. Please type or print clearly in black ink. All copies must be legible. Do not
use pencil. (Submit in triplicate, that is, all six pages of this form.)
Form N-426 (Rev. 06/30/06)Y Page 5
(the United States, American Samoa, Swains Island or the Panama Canal Zone)
Certification of Military or Naval Service.
Name as shown in records:
1. Entered Service at
2. On
3. Served to
4. Branch of
Service
Reserve or National Guard Service.
9. Ended
7. Check Which
Reserve
N. Guard
11. Statement Regarding Alienage. (Complete this item in ALL cases.)
Record shows this person was not discharged on account of alienage.
Record shows this person was discharged on account of alienage. Details:
Complete this block if subject is a "Lodge Act Enlistee"-64 Stat. 316 (Army). Subsequent to enlistment under the Lodge Act on
subject entered
via
pursuant to Military orders on
I CERTIFY that the information here given concerning the service of the person named on the face of this form is correct according to the records
of the
(Official Signature)
[ SEAL ]
Date
By
,
Name correctly shown on front of form.
Active Service.
8. Began
6. Branch of Service
12.
(Name of department or organization)
at the port of
Remarks. Use for continuation of any of the above items. You should also show in the space below any derogatory information in your
records relating to the person's character, loyalty to the United States, disciplinary actions, convictions or other matters concerning his or her
fitness for citizenship.
Applicant: Do not fill out this page.
State whether serving honorably. If separated, state
whether under honorable conditions. If other than
honorable, give full details. Always complete item
11.
State whether serving honorably. State if Selected Reserve
of the Ready Reserve. If separated, state whether under
honorable conditions. If other than honorable, give full
details. Always complete Item 11.
Lodge Act Enlistee.
5.
10.
Form N-426 (Rev. 06/30/06)Y Page 6
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