Affidavits: Written statements sworn (or affirmed)
to by two persons who have personal knowledge
of the claimed event.
U.S. Department of Justice
Immigration and Naturalization Service
OMB# 1115-0152
Application for Certificate of Citizenship in Behalf
of an Adopted Child
INSTRUCTIONS
Marriage certificate of adoptive parents.
Who may file? To use this form, you must be a United
States citizen and the parent of an adopted child who was
born outside the United States. Your spouse (if any) must
also be a United States citizen and also the child's adoptive
parent. The child must be under 18 years of age and
residing with you in the United States as a lawfully admitted
permanent resident alien. The approval of this application
before the child's 18th birthday will make the child a United
States citizen as of the date the application is approved. You
will receive a certificate of citizenship as proof of the child's
citizenship.
If either of the adoptive parents has been previously
married, submit evidence of termination of all prior
marriages.
Any document in a foreign language must be accompanied
by a translation in English. The translator must certify that
he or she is competent to translate and that the translation is
accurate.
What if a document is not available? If the documents
needed are not available you may submit the following (INS
may require a certification from the appropriate civil authority
that the document is not available):
What is the fee? You must pay $145.00 to file this form.
The fee will not be refunded. Do not mail cash. All
checks or money orders must be payable in the U.S.
currency in the United States. Make check or money
order payable to "Immigration and Naturalization Service"
in the exact amount. If the check is not honored, INS will
charge you an additional $30.00.
Church record: A certificate under the church seal
issued within two months of birth.
School record: A letter from authorities of the
school attended.
If you live in Guam and are filing this application in Guam,
make your check payable to "Treasurer, Guam," or if you
live in the U.S. Virgin Islands and are filing this application
there, make it payable to "Commissioner of Finance of the
Virgin Islands."
Census records: State or Federal census record.
What photographs are needed? You must send three
identical, unglazed photographs of the child taken within 30
days of the date of filing of this application. The
photographs must be in natural color and taken without a
hat. The dimensions of the face should be about 1 inch from
the top of the hair to the chin. The face should be a 3/4
frontal view with the entire right ear visible. They must be on
thin paper with a Iight background and not mounted in any
way. The photographs must not be signed but you should
print the child's name and alien registration number in the
center of the back of each photograph in pencil.
For each document needed, you may submit the original
documents or a clear, readable copy (INS may still require
the originals).
Where should the application be filed?
Submit this application at the local INS office having
jurisdiction over your place of residence.
What are the penalties for submitting false information? Title
18 United States Code, Section 1001, states that whoever
willfully and knowingly falsifies a material fact, makes a
false statement, or makes use of a false document will be
fined up to $10,000 or imprisoned up to five years or both.
In addition, civil penalties may be imposed in accordance
with Title 8 United States Code, Section 1324c(a)(2).
What documents are needed?.
Child's Alien Registration Card.
If the child's name has been legally changed since
entry, submit evidence of the name change if not
included in the adoption decree.
What is the authority for collecting this information?
Information on this form is requested to carry out the
immigration laws contained in Title 8 United States Code
1304(c). This information is needed to determine whether
an applicant is eligible for immigration benefits. The
information provided may also be disclosed to other federal,
state, local, and foreign law enforcement and regulatory
agencies during the course of the investigation required by
this Service. It is not necessary to provide this information,
however, if you refuse, your application may be denied.
Evidence of U.S. citizenship of adoptive parent(s).
Submit your birth cerfificate, if born in the United
States; your naturalization certificate, if naturalized;
your certificate of citizenship or FS-240 (Report of
Birth Abroad of United States Citizen). In place of any
of the aforementioned, you may submit your valid,
unexpired U.S. passport.
Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, an agency may not conduct or sponsor an information
collection and a person is not required to respond to an information collection unless it displays a currently valid OMB control number.
We try to create forms and instructions that are accurate, can be easily understood and which impose the least possible burden on
you. Often this is difficult because some immigration laws are very complex. The estimated average time to complete and file this
application is as follows: (1) 15 minutes to learn the law and form; (2) 20 minutes to complete the form; and (3) 30 minutes to
assemble and file the petition, for a total estimated average of 1 hour and 5 minutes per petition. If you have comments regarding the
accuracy of this estimate, or suggestions for making this form simpler, you can write to the Immigration and Naturalization Service,
425 I Street, NW, Room 4034, Washington DC 20536; OMB No. 1115-0152.
DO NOT MAIL YOUR COMPLETED APPLICATION
TO THIS ADDRESS.
Child's Birth Certificate.
Final adoption decree.
Form N-643 (12/06/01)Y Page1
