N-600, Application for Certificate of CitizenshipDRAFT Not
for
For USCIS
Use Only
I am an ADOPTED child of a U.S. citizen parent.I am a BIOLOGICAL
child of a U.S. citizen parent.
This application is being filed based on the fact that: (Select
only one box)
Part 1. Information About Your Eligibility Enter Your 9 Digit
A-Number:
Date Stamp
Family Name (Last Name) Given Name (First Name) Middle Name
1.
Family Name (Last Name) Given Name (First Name)
Your Name Exactly As It Appears on Your Permanent Resident Card (if
different from above)2.
Middle Name
A-
U.S. Citizenship and Immigration Services
USCIS Form N-600
Middle NameGiven Name (First Name)Family Name (Last Name)
Other Names You Have Used Since Birth Provide all other names you
have ever used, include nicknames, maiden name, and aliases.
3.
Country of Birth7.
NOTE: Provide information about yourself if you are an applicant
applying for the Certificate of Citizenship. Provide information
about your child if you are a U.S. citizen parent applying for a
Certificate of Citizenship for your minor child.
NOTE: If you need extra space to complete this section, use the
space provided in Part 11. Additional Information.
Gender Male Female
Attorney State Bar Number Select this box if Form G-28.
Attorney or Accredited Representative USCIS Online Account
Number
Page 2 of 15Form N-600 11/08/19
DRAFT Not for
11. Physical Address
City or Town State ZIP Code + 4
-
10. Mailing Address
Other (Explain):
14. Information About Your Admission into the United States and
Current Immigration Status
Marriage Annulled
Port-of-Entry
A.
Middle NameGiven Name (First Name)Family Name (Last Name)
City or Town State ZIP Code + 4
NumberFlr.Ste.Apt.Street Number and Name
U.S. Armed Forces13.
NoYesAre you a member or veteran of any branch of the U.S. Armed
Forces?
I used the following travel document to be admitted to the United
StatesB.
Travel Document Passport
Passport Number Travel Document Number
Country of Issuance for Passport or Travel Document Date Passport
or Travel Document Issued (mm/dd/yyyy)
DRAFT Not for
A-Part 2. Information About You (continued)
I obtained LPR status through adjustment of status in the United
States or admission as a LPR. D.
Date I became a LPR (mm/dd/yyyy)
U.S. Citizenship and Immigration Services (USCIS) Office That
Granted My LPR Status or Location Where I Was Admitted
NoYesHave you previously applied for a Certificate of Citizenship
or U.S. Passport?15. If you answered "Yes" to Item Number 15.,
provide an explanation below. If you need extra space to complete
this section, use the space provided in Part 11. Additional
Information.
NoYes16. Have you ever abandoned or lost your LPR status? If you
answered "Yes" to Item Number 16., provide an explanation below. If
you need extra space to complete this section, use the space
provided in Part 11. Additional Information.
NoYesWere you adopted?17. If you answered "Yes" to Item Number 17.,
complete Items A. - D.
Place of Final AdoptionA.
NoYesDid you have to be re-adopted in the United States?18. If you
answered "Yes" to Item Number 18., complete Items A. - D.
Date of Final Adoption (mm/dd/yyyy)
B.
My most recent immigration status in the United States was:C.
A Lawful Permanent Resident (LPR) A Nonimmigrant
Other (Explain):
A Refugee/Asylee
NOTE: If you select “Other” and you need extra space to complete
this section, use the space provided in Part 11. Additional
Information.
StateCity or Town Country
C. Date Physical Custody Began (mm/dd/yyyy)
D.
C. Date Physical Custody Began (mm/dd/yyyy)
D.Date of Adoption (mm/dd/yyyy)
B.
NoYesWere your parents married to each other when you were born (or
adopted)?19.
NoYesDid your parents marry after you were born?20.
NoYesDo you regularly reside in the United States in the legal and
physical custody of your U.S. citizen parent(s), or, if over 18
years of age, did you regularly reside in the legal and physical
custody of your U.S. citizen parent(s) before turning 18 years of
age?
21.
DRAFT Not for
Date You Left the United States (mm/dd/yyyy)
A. Date You Returned to the United States (mm/dd/yyyy)
B.
D. Date You Returned to the United States (mm/dd/yyyy)
E.
2.
3.
Native Hawaiian or Other Pacific Islander
Not Hispanic or LatinoHispanic or Latino Ethnicity (Select only one
box)1.
4. Weight Pounds
Other
Bald (No hair)
Unknown/ Other
Complete the following information only if you are claiming U.S.
citizenship at the time of birth if you were born before October
10, 1952. If you need extra space to complete this section, use the
space provided in Part 11. Additional Information.
NoYesHave you been absent from the United States since you first
arrived?22.
StateCity or Town
F. Place of Entry Upon Return to the United States
StateCity or Town
C. Place of Entry Upon Return to the United States
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father)
NOTE: Complete this section if you are claiming citizenship through
a U.S. biological father (or adoptive father). Provide information
about yourself if you are a U.S. citizen father applying for a
Certificate of Citizenship on behalf of your minor biological or
adopted child.
Current Legal Name of U.S. Citizen Father
Family Name (Last Name) Given Name (First Name) Middle Name
1.
Asian
DRAFT Not for
Production 06/10/2020
A-Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father) (continued)
My father is a U.S. citizen by6.
A- Alien Registration Number (A-Number) Certificate of Citizenship
Number
A- A-NumberCertificate of Naturalization Number
NoYesHas your father ever lost U.S. citizenship or taken any action
that would cause loss of U.S. citizenship?7.
If you answered “Yes” to Item Number 7., provide an explanation in
Part 11. Additional Information.
What is your U.S. citizen father's current marital status?
DivorcedSingle, Never Married WidowedMarried Marriage Annulled
Separated
Marital History8.
A. How many times has your U.S. citizen father been married
(including annulled marriages and marriages to the same
person)?
B.
If you selected "Other," provide an explanation. If you need extra
space to complete this section, use the space provided in Part 11.
Additional Information.
Other (Explain):
Birth in the United States Acquisition after birth through
naturalization of alien parent(s)
Birth abroad to U.S. citizen parent(s)
Naturalization
City or Town State ZIP Code + 4
-
StateCity or Town
Place of Naturalization (Name of Court or USCIS Office
Location)
Date of Naturalization (mm/dd/yyyy)
2. Date of Birth (mm/dd/yyyy) Country of Birth 3. Country of
Citizenship or Nationality4.
Page 6 of 15Form N-600 11/08/19
DRAFT Not for
Production 06/10/2020
A-Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father) (continued)
Date of Marriage (mm/dd/yyyy)
F.
If you selected "Other," provide an explanation. If you need extra
space to complete this section, use the space provided in Part 11.
Additional Information.
NoYesIs your U.S. citizen father's current spouse also your
biological (or adopted) mother?I.
H.
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother)
NOTE: Complete this section if you are claiming citizenship through
a U.S. citizen biological mother (or adoptive mother). Provide
information about yourself if you are a U.S. citizen mother
applying for a Certificate of Citizenship on behalf of your minor
biological or adopted child.
Current Legal Name of U.S. Citizen Mother
Family Name (Last Name) Given Name (First Name) Middle Name
1.
2. Date of Birth (mm/dd/yyyy) Country of Birth 3. Country of
Citizenship or Nationality4.
Other (Explain):
City or Town State ZIP Code + 4 -
Postal Code (foreign address only)
Province (foreign address only)
Information About U.S. Citizen Father's Current Spouse9.
A. Middle Name Given Name (First Name)Family Name (Last Name)
Page 7 of 15Form N-600 11/08/19
DRAFT Not for
Production 06/10/2020
A-Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother) (continued)
NoYesHas your mother ever lost U.S. citizenship or taken any action
that would cause loss of U.S. citizenship?7.
If you answered “Yes” to Item Number 7., provide an explanation in
Part 11. Additional Information.
What is your U.S. citizen mother's current marital status?
DivorcedSingle, Never Married WidowedMarried Marriage Annulled
Separated
Marital History8.
A. How many times has your U.S. citizen mother been married
(including annulled marriages and marriages to the same
person)?
B.
Other (Explain):
If you selected “Other,” provide an explanation. If you need extra
space to complete this section, use the space provided in Part 11.
Additional Information.
Information About U.S. Citizen Mother's Current Spouse9.
A. Middle Name Given Name (First Name)Family Name (Last Name)
Place of Naturalization (Name of Court or USCIS Office
Location)
A- A-NumberCertificate of Naturalization Number
Naturalization
A- Alien Registration Number (A-Number) Certificate of Citizenship
Number
Birth in the United States Acquisition after birth through
naturalization of alien parent(s)
Birth abroad to U.S. citizen parent(s)
5. Physical Address
City or Town State ZIP Code + 4
-
StateCity or Town
Date of Naturalization (mm/dd/yyyy)
DRAFT Not for
Production 06/10/2020
NoYesIs your U.S. citizen mother's current spouse also your
biological (or adopted) father?I.
A-Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother) (continued)
Part 6. Physical Presence in the United States From Birth Until
Filing of Form N-600
NOTE: Only applicants born outside the United States claiming to
have been born U.S. citizens are required to provide all the dates
when your U.S. citizen biological father or U.S. citizen biological
mother resided in the United States. Include all dates from your
birth until the date you file your Form N-600.
Indicate whether this information relates to your U.S. citizen
father or mother
U.S. Citizen Father U.S. Citizen Mother
Physical Presence in the United States
Spouse's Immigration Status Lawful Permanent ResidentU.S.
Citizen
H.
Other
If you selected “Other,” provide an explanation. If you need extra
space to complete this section, use the space provided in Part 11.
Additional Information.
1.
2.
Date of Marriage (mm/dd/yyyy)F.
City or Town State ZIP Code + 4 -
Postal Code (foreign address only)
Province (foreign address only)
StateCity or Town
DRAFT Not for
Production 06/10/2020
A-Part 7. Information About Military Service of U. S. Citizen
Parents
NOTE: Complete this only if you are an applicant claiming U.S.
citizenship at time of birth abroad.
NoYesHas your U.S. citizen parent served in the U.S. Armed
Forces?1.
If you answered "Yes" to Item Number 1., which parent served in the
U.S. Armed Forces?
U.S. Citizen Father U.S. Citizen Mother
2.
Dates of Service (mm/dd/yyyy) (If time of service fulfills any of
the required physical presence, submit evidence of the
service.)3.
Type of Discharge4.
Part 8. Applicant's Statement, Contact Information, Certification,
and Signature
NOTE: Read the Penalties section of the Form N-600 Instructions
before completing this section.
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
understood everything. every question, in The interpreter named in
Part 9. read to me every question and instruction on this
application and my answer to
, a language in which I am fluent and I 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
At my request, the preparer named in Part 10., , 2. Applicant's
Statement Regarding the Preparer
prepared this application for me based only upon information I
provided or authorized.
Applicant's Contact Information
Applicant's Email Address (if any)
3.
5.
4.
I furthermore authorize release of information contained in this
application, in supporting documents, and in my USCIS records, to
other entities and persons where necessary for the administration
and enforcement of U.S. immigration law.
Copies of any documents I have submitted are exact photocopies of
unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date.
Furthermore, I authorize the release of any information from any
and all of my records that USCIS may need to determine my
eligibility for the immigration benefit that I seek.
Applicant's Certification
DRAFT Not for
A-Part 8. Applicant's Statement, Contact Information,
Certification, and Signature (continued)
I understand that USCIS may require me to appear for an appointment
to take my biometrics (fingerprints, photograph, and/or signature)
and, at that time, if I am required to provide biometrics, I will
be required to sign an oath reaffirming that:
Applicant's Signature
Applicant's Signature Date of Signature (mm/dd/yyyy)6.
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.
2) I understood all of the information contained in, and submitted
with, my application; and
3) All of this information was complete, true, and correct at the
time of filing.
1) I reviewed and provided or authorized all of the information in
my application;
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.
Interpreter's Business or Organization Name (if any)2.
Interpreter's Given Name (First Name)Interpreter's Family Name
(Last Name)1.
Provide the following information about the interpreter.
Interpreter's Full Name
City or Town State
Country
Interpreter's Email Address (if any)6.
Interpreter's Mobile Telephone Number (if any)5.
Page 11 of 15Form N-600 11/08/19
DRAFT Not for
A-Part 9. 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 8., Item B. in Item Number 1., and I have read to
this applicant in the identified language every question and
instruction on this application and his or her answer to every
question. The applicant informed me that he or she understands
every instruction, question, and answer on the application,
including the Applicant's Certification, and has verified the
accuracy of every answer.
Date of Signature (mm/dd/yyyy)Interpreter's Signature
Interpreter's Signature 7.
Part 10. 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 Business or Organization Name (if any) 2.
3. Street Number and Name Apt. Flr. NumberSte.
City or Town State
Preparer's Daytime Telephone Number Preparer's Mobile Telephone
Number (if any)
Preparer's Email Address (if any)
4.
6.
5.
DRAFT Not for
A-Part 10. Contact Information. Declaration, and Signature of the
Person Preparing this Application, if Other Than the Applicant
(continued)
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.
B. extends
NOTE: If you are an attorney or accredited representative, you may
need to submit a completed Form G-28, Notice of Entry of Appearance
as Attorney or Accredited Representative, with this application.
Members of the Armed Forces applying outside the United States for
a Certificate of Citizenship under INA section 320 may file Form
G-28I, Notice of Entry of Appearance as Attorney In Matters Outside
the Geographical Confines of the United States with this
application, if applicable.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant. The
applicant then reviewed this completed application and informed me
that he or she understands all of the information contained in, and
submitted with, his or her application, including the Applicant's
Certification, and that all of this information is complete, true,
and correct. I completed this application based only on information
that the applicant provided to me or authorized me to obtain or
use.
Preparer's Signature Date of Signature (mm/dd/yyyy)
Preparer's Signature
DRAFT Not for
Item NumberPart NumberPage Number B.
B.
C.
C.
D.
D.
A.
A.
If you need extra space to provide any additional information
within this application, use the space below. If you need more
space than what is provided, you may make copies of this page to
complete and file with this application or attach a separate sheet
of paper. Type or print your name and A-Number at the top of each
sheet; indicate the Page Number, Part Number, and Item Number to
which your answer refers; and sign and date each sheet.
A-Number A-
Page Number B. Part Number C. Item Number
1. Family Name (Last Name) Given Name (First Name) Middle
Name
D.
A.
D.
DRAFT Not for
Production 06/10/2020
A-Part 12. Affidavit (do NOT complete this part unless instructed
to do so AT THE INTERVIEW)
NOTE: Do not complete Parts 12. and 13. unless the USCIS officer
instructs you to do so at the interview.
do swear or affirm, underI, the (applicant, parent, or legal
guardian) penalty of perjury under the laws of the United States,
that I know and understand the contents of this application signed
by me, and the attached supplementary pages number to inclusive,
that the same are true and correct to the best of my knowledge, and
that corrections number to were made by me or at my request.
Applicant's, Parent's, or Legal Guardian's Signature Date of
Signature (mm/dd/yyyy)
Subscribed and sworn or affirmed before me upon examination of the
applicant (parent, or legal guardian) on
USCIS Officer's Printed Name
Date of Signature (mm/dd/yyyy)
On the basis of the documents, records, the testimony of persons
examined, and the identification upon personal appearance of the
underage beneficiary, I find that all the facts and conclusions set
forth under oath in this application are:
True and correct1.
The applicant derived or acquired U.S. citizenship on 2. Date
(mm/dd/yyyy)
The applicant derived or acquired U.S. citizenship through (Select
the box next to the appropriate section of law, or if the section
of law is not reflected, type or print the applicable section of
law in the space next to “Other.”)
3.
The applicant has not been expatriated since that time4.
Part 13. Officer Report and Recommendation on Application for
Certificate of Citizenship (for USCIS use ONLY)
at (Location)
Date (mm/dd/yyyy).
DRAFT Not for
Production 06/10/2020
A-Part 13. Officer Report and Recommendation on Application for
Certificate of Citizenship (for USCIS use ONLY) (continued)
DeniedApprovedI recommend that this Form N-600 be:
Issue Certificate of Citizenship in the name of
Family Name (Last Name) Given Name (First Name) Middle Name
USCIS Officer's Printed Name
Date of Signature (mm/dd/yyyy)
USCIS District Director's or Field Office Director's Signature Date
of Signature (mm/dd/yyyy)
do not concur with the USCIS Officer's recommendation of Form
N-600.I do
Page of
For USCIS Use Only
I am an ADOPTED child of a U.S. citizen parent.
I am a BIOLOGICAL child of a U.S. citizen parent.
This application is being filed based on the fact that:
(Select only one box)
Part 1. Information About Your Eligibility
Enter Your 9 Digit A-Number:
Date Stamp
Family Name (Last Name)
Given Name (First Name)
Family Name (Last Name)
Given Name (First Name)
Your Name Exactly As It Appears on Your Permanent Resident
Card (if different from above)
2.
Department of Homeland Security
U. S. Department of Homeland Security Logo.
USCIS
Expires 11/30/2021
Given Name (First Name)
Family Name (Last Name)
Other Names You Have Used Since Birth Provide all other names you
have ever used, include nicknames, maiden name, and aliases.
3.
6.
Date of Birth (mm/dd/yyyy)
Date of Birth (m m /d d/ y y y y)
U.S. Social Security Number
Right pointing arrow.
NOTE: Provide information about yourself if you are an
applicant applying for the Certificate of Citizenship.
Provide information about your child if you are a U.S. citizen
parent applying for a Certificate of Citizenship for your minor
child.
NOTE: If you need extra space to complete this section, use
the space provided in Part 11. Additional Information.
Gender
9.
8.
Attorney or Accredited Representative USCIS Online
Account Number
Part 2. Information About You (continued)
A-
11.
Number
Flr.
Ste.
Apt.
-
Province (foreign address only)
Country (foreign address only)
12.
14.
Information About Your Admission into the United States and Current
Immigration Status
I arrived in the following manner:
Port-of-Entry
A.
Middle Name
Province (foreign address only)
Country (foreign address only)
13.
Are you a member or veteran of any branch of the U.S. Armed
Forces?
I used the following travel document to be admitted to the United
States
B.
Date Passport or Travel Document Issued (mm/dd/yyyy)
A-
Part 2. Information About You (continued)
I obtained LPR status through adjustment of status in the United
States or admission as a LPR.
D. I obtained Lawful Permanent Resident (L P R) status through
adjustment of status in the United States or admission as a Lawful
Permanent Resident (L P R) (if applicable)
D.
Date I became a LPR (mm/dd/yyyy)
U.S. Citizenship and Immigration Services (USCIS) Office That
Granted My LPR Status or Location Where I Was Admitted
U.S. Citizenship and Immigration Services (U S C I S) Office That
Granted My Lawful Permanent Resident (L P R) Status or Location
Where I Was Admitted.
Have you previously applied for a Certificate of Citizenship or
U.S. Passport?
15.
If you answered "Yes" to Item Number 15., provide an
explanation below. If you need extra space to complete this
section, use the space provided in Part 11. Additional
Information.
16.
Have you ever abandoned or lost your LPR status?
16. Have you ever abandoned or lost your Lawful Permanent Resident
(L P R) status?
If you answered "Yes" to Item Number 16., provide an
explanation below. If you need extra space to complete this
section, use the space provided in Part 11. Additional
Information.
Were you adopted?
17.
If you answered "Yes" to Item Number 17.,
complete Items A. - D.
Place of Final Adoption
Did you have to be re-adopted in the United States?
18.
If you answered "Yes" to Item Number 18.,
complete Items A. - D.
Date of Final Adoption (mm/dd/yyyy)
B.
My most recent immigration status in the United States was:
C.
A Nonimmigrant
Other (Explain):
A Refugee/Asylee
NOTE: If you select “Other” and you need extra space to
complete this section, use the space provided in Part 11.
Additional Information.
State
C.
D.
C.
D.
B.
Were your parents married to each other when you were born (or
adopted)?
19.
20.
Do you regularly reside in the United States in the legal and
physical custody of your U.S. citizen parent(s), or, if over 18
years of age, did you regularly reside in the legal and physical
custody of your U.S. citizen parent(s) before turning 18 years of
age?
21.
A-
Date You Left the United States (mm/dd/yyyy)
A.
B.
D.
E.
2.
3.
1.
4.
Weight
Pounds
5.
Brown
Blue
Green
Hazel
Gray
Black
Pink
Maroon
Unknown/
Other
Bald
6.
Unknown/Other
Complete the following information only if you are claiming
U.S. citizenship at the time of birth if you were born
before October 10, 1952. If you need extra space to
complete this section, use the space provided in Part 11.
Additional Information.
Have you been absent from the United States since you first
arrived?
22.
State
State
Place of Entry Upon Return to the United States
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father)
NOTE: Complete this section if you are claiming citizenship
through a U.S. biological father (or adoptive father).
Provide information about yourself if you are a U.S. citizen father
applying for a Certificate of Citizenship on behalf of your minor
biological or adopted child.
Current Legal Name of U.S. Citizen Father
Family Name (Last Name)
Given Name (First Name)
Part 4. Information About Your U.S. Citizen Biological
Father(or Adoptive Father) (continued)
My father is a U.S. citizen by
6.
Certificate of Naturalization Number
Has your father ever lost U.S. citizenship or taken any action that
would cause loss of U.S. citizenship?
7.
If you answered “Yes” to Item Number 7., provide an
explanation in Part 11. Additional Information.
What is your U.S. citizen father's current marital status?
Marital History
8.
A.
How many times has your U.S. citizen father been married (including
annulled marriages and marriages to the same person)?
B.
If you selected "Other," provide an explanation. If you need
extra space to complete this section, use the space provided inPart
11. Additional Information.
Birth in the United States
Acquisition after birth through naturalization of alien
parent(s)
Birth abroad to U.S. citizen parent(s)
Naturalization
5.
Number
Flr.
Ste.
Apt.
-
Province (foreign address only)
Country (foreign address only)
Place of Naturalization (Name of Court or USCIS Office
Location)
Date of Naturalization (mm/dd/yyyy)
Date of Birth (mm/dd/yyyy)
Date of Birth (m m /d d/ y y y y)
Country of Birth
4.
A-
Part 4. Information About Your U.S. Citizen Biological
Father(or Adoptive Father) (continued)
Date of Marriage (mm/dd/yyyy)
F.
If you selected "Other," provide an explanation. If you
need extra space to complete this section, use the space provided
in Part 11. Additional Information.
Is your U.S. citizen father's current spouse also your biological
(or adopted) mother?
I.
H.
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother)
NOTE: Complete this section if you are claiming citizenship
through a U.S. citizen biological mother (or adoptive
mother). Provide information about yourself if you are a
U.S. citizen mother applying for a Certificate of Citizenship on
behalf of your minor biological or adopted child.
Current Legal Name of U.S. Citizen Mother
Family Name (Last Name)
Given Name (First Name)
Date of Birth (mm/dd/yyyy)
Date of Birth (m m /d d/ y y y y)
Country of Birth
4.
D.
Province (foreign address only)
9.
A.
Part 5. Information About Your U.S. Citizen Biological
Mother(or Adoptive Mother) (continued)
Has your mother ever lost U.S. citizenship or taken any action that
would cause loss of U.S. citizenship?
7.
If you answered “Yes” to Item Number 7., provide an
explanation in Part 11. Additional Information.
What is your U.S. citizen mother's current marital status?
Marital History
8.
A.
How many times has your U.S. citizen mother been married (including
annulled marriages and marriages to the same person)?
B.
If you selected “Other,” provide an explanation. If you need
extra space to complete this section, use the space provided inPart
11. Additional Information.
Information About U.S. Citizen Mother's Current Spouse
9.
A.
6.
Acquisition after birth through naturalization of alien
parent(s)
Birth abroad to U.S. citizen parent(s)
5.
Number
Flr.
Ste.
Apt.
-
Province (foreign address only)
Country (foreign address only)
Date of Naturalization (mm/dd/yyyy)
Is your U.S. citizen mother's current spouse also your biological
(or adopted) father?
I.
A-
Part 5. Information About Your U.S. Citizen Biological
Mother(or Adoptive Mother) (continued)
Part 6. Physical Presence in the United States From Birth
Until Filing of Form N-600
NOTE: Only applicants born outside the United States claiming
to have been born U.S. citizens are required to provide all the
dates when your U.S. citizen biological father or U.S. citizen
biological mother resided in the United States. Include all
dates from your birth until the date you file your Form
N-600.
Indicate whether this information relates to your U.S.
citizen father or mother
Physical Presence in the United States
Spouse's Immigration Status
H.
If you selected “Other,” provide an explanation. If you need extra
space to complete this section, use the space provided inPart 11.
Additional Information.
1.
2.
Province (foreign address only)
D.
State
G.
Country
A-
Part 7. Information About Military Service of U. S. Citizen
Parents
NOTE: Complete this only if you are an applicant claiming
U.S. citizenship at time of birth abroad.
Has your U.S. citizen parent served in the U.S. Armed Forces?
1.
If you answered "Yes" to Item Number 1., which parent served
in the U.S. Armed Forces?
2.
Dates of Service (mm/dd/yyyy) (If time of service fulfills any of
the required physical presence, submit evidence of the
service.)
3.
Part 8. Applicant's Statement, Contact Information, Certification,
and Signature
NOTE: Read the Penalties section of the Form N-600
Instructions before completing this section.
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.
understood everything.
every question, in
The interpreter named in Part 9. read to me every question and
instruction on this application and my answer to
, a language in which I am fluent and I
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
prepared this application for me based only upon information I
provided or authorized.
Applicant's Contact Information
Applicant's Email Address (if any)
3.
5.
4.
I furthermore authorize release of information contained in this
application, in supporting documents, and in my USCIS records, to
other entities and persons where necessary for the administration
and enforcement of U.S. immigration law.
I further authorize release of information contained in this
application, in supporting documents, and in my U S C I S records
to other entities and persons where necessary for the
administration and enforcement of U.S. immigration laws.
Copies of any documents I have submitted are exact photocopies of
unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date.
Furthermore, I authorize the release of any information from any
and all of my records that USCIS may need to determine my
eligibility for the immigration benefit that I seek.
Copies of any documents I have submitted are exact photocopies of
unaltered, original documents, and I understand that U S C I S may
require that I submit original documents to U S C I S at a later
date. Furthermore, I authorize the release of any information from
any of my records that U S C I S may need to determine my
eligibility for the immigration benefit I seek.
Applicant's Certification
Part 8. Applicant's Statement, Contact Information,
Certification, and Signature (continued)
I understand that USCIS may require me to appear for an appointment
to take my biometrics (fingerprints, photograph, and/or signature)
and, at that time, if I am required to provide biometrics, I will
be required to sign an oath reaffirming that:
Applicant's Signature
Applicant's Signature
6.
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.
2) I understood all of the information contained in, and
submitted with, my application; and
3) All of this information was complete, true, and correct at
the time of filing.
1) I reviewed and provided or authorized all of the
information in my application;
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.
Interpreter's Business or Organization Name (if any)
2.
1.
Interpreter's Full Name
City or Town
6.
5.
Right pointing arrow.
(continued)
I am fluent in English
and
, which is the same language specified in Part 8.,
Item B. in Item Number 1., and I have read to this applicant
in the identified language every question and instruction on this
application and his or her answer to every question. The
applicant informed me that he or she understands every instruction,
question, and answer on the application, including
the Applicant's Certification, and has verified the accuracy
of every answer.
Date of Signature (mm/dd/yyyy)
7.
Part 10. 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
1.
2.
3.
Preparer's Email Address (if any)
4.
6.
5.
A-
Part 10. Contact Information. Declaration, and Signature of
the PersonPreparing this Application, if Other Than the
Applicant (continued)
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.
A.
B.
extends
NOTE: If you are an attorney or accredited representative,
you may need to submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative, with this
application. Members of the Armed Forces applying outside the
United States for a Certificate of Citizenship under INA section
320 may file Form G-28I, Notice of Entry of Appearance as Attorney
In Matters Outside the Geographical Confines of the United States
with this application, if applicable.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant.
The applicant then reviewed this completed application and informed
me that he or she understands all of the information contained in,
and submitted with, his or her application, including
the Applicant's Certification, and that all of this
information is complete, true, and correct. I completed this
application based only on information that the applicant provided
to me or authorized me to obtain or use.
Preparer's Signature
B.
B.
C.
C.
D.
D.
A.
A.
If you need extra space to provide any additional information
within this application, use the space below. If you need
more space than what is provided, you may make copies of this page
to complete and file with this application or attach a separate
sheet of paper. Type or print your name and A-Number at
the top of each sheet; indicate the Page Number, Part
Number, and Item Number to which your answer refers; and sign
and date each sheet.
A-Number
D.
4.
B.
C.
A.
A-
Part 12. Affidavit (do NOT complete this part
unless instructed to do so
AT THE INTERVIEW)
NOTE: Do not complete Parts 12. and 13. unless the USCIS officer
instructs you to do so at the interview.
NOTE: Do not complete Parts 12. and 13. unless the U S C I S
officer instructs you to do so at the interview.
do swear or affirm, under
I, the (applicant, parent, or legal guardian)
penalty of perjury under the laws of the United States, that I know
and understand the contents of this application signed by me, and
the attached supplementary pages number to inclusive, that the same
are true and correct to the best of my knowledge, and that
corrections number to were made by me or at my request.
Applicant's, Parent's, or Legal Guardian's Signature
Date of Signature (mm/dd/yyyy)
Subscribed and sworn or affirmed before me upon examination of the
applicant (parent, or legal guardian) on
USCIS Officer's Printed Name
Date of Signature (mm/dd/yyyy)
On the basis of the documents, records, the testimony of persons
examined, and the identification upon personal appearance of the
underage beneficiary, I find that all the facts and conclusions set
forth under oath in this application are:
True and correct
2.
Date (mm/dd/yyyy)
The applicant derived or acquired U.S. citizenship through (Select
the box next to the appropriate section of law, or if the section
of law is not reflected, type or print the applicable section of
law in the space next to “Other.”)
3.
4.
Part 13. Officer Report and Recommendation on Application for
Certificate of Citizenship(for USCIS use ONLY)
Part 13. Officer Report and Recommendation on Application for
Certificate of Citizenship (for U S C I S use ONLY)
at
(Location)
Part 13. Officer Report and Recommendation on Application
forCertificate of Citizenship (for USCIS use ONLY)
(continued)
Part 13. Officer Report and Recommendation on Application for
Certificate of Citizenship (for U S C I S use ONLY)
(continued)
Denied
Approved
Issue Certificate of Citizenship in the name of
Family Name (Last Name)
Given Name (First Name)
Date of Signature (mm/dd/yyyy)
do not concur with the USCIS Officer's recommendation of Form
N-600.
I do
02/13/2017 N
02/13/2017 N
CurrentPage:
PageCount:
Part 1. Information About the Your Eligibility. 1. This
application is being filed based on the fact that. (Select only one
box). Select this Box for I am a BIOLOGICAL child of a U.S. citizen
parent.:
Part 11. Additional Information. If you need extra space to provide
any additional information within this application, use the space
below. If you need more space than what is provided, you may make
copies of this page to complete and file with this application or
attach a separate sheet of paper. Type or print your name and. A.
Number (if any) at the top of each sheet; indicate the Page Number,
Part Number, and Item Number to which your answer refers; and sign
and date each sheet. 1. Middle Name. This is a read only field.
This field pre-populates from page 1.:
Part 11. Additional Information. If you need extra space to provide
any additional information within this application, use the space
below. If you need more space than what is provided, you may make
copies of this page to complete and file with this application or
attach a separate sheet of paper. Type or print your name and. A.
Number (if any) at the top of each sheet; indicate the Page Number,
Part Number, and Item Number to which your answer refers; and sign
and date each sheet. 1. Enter Family Name (Last Name). 1. Given
Name (First Name). This is a read only field. This field
pre-populates from page 1.:
Part 11. Additional Information. If you need extra space to provide
any additional information within this application, use the space
below. If you need more space than what is provided, you may make
copies of this page to complete and file with this application or
attach a separate sheet of paper. Type or print your name and. A.
Number (if any) at the top of each sheet; indicate the Page Number,
Part Number, and Item Number to which your answer refers; and sign
and date each sheet. 1. Family Name (Last Name). This is a read
only field. This field pre-populates from page 1.:
Part 2. Information About You. 2. Your Name Exactly As It Appears
on Your Permanent Resident Card (if different from above). Enter
Family Name (Last Name).:
Part 2. Information About You. 2. Your Name Exactly As It Appears
on Your Permanent Resident Card (if different from above). Enter
Given Name (First Name).:
Part 2. Information About You. 2. Your Name Exactly As It Appears
on Your Permanent Resident Card (if different from above). Enter
Middle Name.:
Alien Registration Number (A. Number). This is a read only field.
This field is pre-populated from Page 1.:
Part 2. Information About You. 3. Other Names You Have Used Since
Birth. Provide all other names you have ever used, include
nicknames, maiden name, and aliases. Enter Middle Name.:
Part 2. Information About You. 3. Other Names You Have Used Since
Birth. Provide all other names you have ever used, include
nicknames, maiden name, and aliases. Enter Given Name (First
Name).:
Part 2. Information About You. 3. Other Names You Have Used Since
Birth. Provide all other names you have ever used, include
nicknames, maiden name, and aliases. Enter Family Name (Last Name).
Line Two of Two.:
Part 2. Information About You. 3. Other Names You Have Used Since
Birth. Provide all other names you have ever used, include
nicknames, maiden name, and aliases. Enter Middle Name.:
Part 2. Information About You. 3. Other Names You Have Used Since
Birth. Provide all other names you have ever used, include
nicknames, maiden name, and aliases. Enter Given Name (First
Name).:
Part 2. Information About You. 3. Other Names You Have Used Since
Birth. Provide all other names you have ever used, include
nicknames, maiden name, and aliases. Enter Family Name (Last Name).
Line One of Two.:
Part 2. Information About You. 6. Date of Birth (mm/dd/yyyy).
Enter Date as 2-digit Month, 2-digit Day, and 4-digit Year.:
Part 2. Information About You. 7. Enter Country of
Birth.:
Part 2. Information About You. 4. Enter U.S. Social Security
Number (if any).:
Part 2. Information About You. 5. Enter U S C I S Online
Account Number (if any).:
Part 1. Information About the Your Eligibility. 1. Other.
Explain Fully. NOTE: If you need extra space to complete this
section, use the space provided in Part 11. Additional
Information.:
Part 2. Information About You. 9. Gender. Select this Box for
Female.:
Part 2. Information About You. 8. Enter Country of Prior
Citizenship or Nationality.:
To be completed by an attorney or accredited representative, if
any. Select this box if Form G - 28 is attached.: 0
To be completed by an attorney or accredited representative, if
any. Enter Attorney State Bar Number, if applicable.:
To be completed by an attorney or accredited representative, if
any. Enter Attorney or Accredited Representative U S C I S Online
Account Number, if any. Enter 12 digits.:
Part 2. Information About You. 11. Physical Address. Enter
City or Town. :
Part 2. Information About You. 11. Physical Address. Select
State from a List of States.:
Part 2. Information About You. 11. Physical Address. Enter
Zip Code Plus 4. Enter 5-digit Zip Code.:
Part 2. Information About You. 11. Physical Address. Enter
Zip Code Plus 4. Enter 4-digit Zip Code Extension.:
Part 2. Information About You. 11. Physical Address. Enter
Apartment, Suite, or Floor Number.:
Part 2. Information About You. 11. Physical Address. Select
this Box for Apartment.:
Part 2. Information About You. 11. Physical Address. Enter
Street Number and Name (Do not provide a P O Box in this space
unless it is your ONLY address.) :
Part 2. Information About You. 11. Physical Address. Enter
Postal Code (foreign address only).:
Part 2. Information About You. 11. Physical Address. Enter
Province (foreign address only).:
Part 2. Information About You. 11. Physical Address. Enter
Country (foreign address only).:
Part 2. Information About You. 10. Mailing Address. Enter In
Care Of Name (if any).:
Part 2. Information About You. 12. Current Marital Status.
Select this Box for Marriage Annulled.:
Part 2. Information About You. 12. Current Marital Status.
Enter Other (Explain).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. G. Place of Marriage. Enter City or Town.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. A.
I arrived in the following manner. Port-of-Entry. 2. Date of Entry.
Enter Date as 2-digit Month, 2-digit Day, and 4-digit Year.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. A.
I arrived in the following manner. Port-of-Entry. Exact Name Used
at Time of Entry. Enter Middle Name.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. A.
I arrived in the following manner. Port-of-Entry. Exact Name Used
at Time of Entry. Enter Mother's Given Name (First Name).:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. A.
I arrived in the following manner. Port-of-Entry. Exact Name Used
at Time of Entry. Enter Family Name (Last Name).:
Part 2. Information About You. 10. Mailing Address. Enter
City or Town. :
Part 2. Information About You. 10. Mailing Address. Select
State from a List of States.:
Part 2. Information About You. 10. Mailing Address. Enter Zip
Code Plus 4. Enter 5-digit Zip Code.:
Part 2. Information About You. 10. Mailing Address. Enter Zip
Code Plus 4. Enter 4-digit Zip Code Extension.:
Part 2. Information About You. 10. Mailing Address. Enter
Apartment, Suite, or Floor Number.:
Part 2. Information About You. 10. Mailing Address. Select
this Box for Apartment.:
Part 2. Information About You. 10. Mailing Address. Enter
Street Number and Name. :
Part 2. Information About You. 10. Mailing Address. Enter
Postal Code (foreign address only).:
Part 2. Information About You. 10. Mailing Address. Enter
Province (foreign address only).:
Part 2. Information About You. 10. Mailing Address. Enter
Country (foreign address only).:
Part 2. Information About You. 13. U.S. Armed Forces. Are you
a member or veteran of any branch of the U.S. Armed Forces? Select
this Box for Yes.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. B.
I used the following travel document to be admitted to the United
States. Select this Box for Travel Document.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. B.
I used the following travel document to be admitted to the United
States. Select this Box for Passport.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. B.
I used the following travel document to be admitted to the United
States. Enter Passport Number.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. B.
I used the following travel document to be admitted to the United
States. Enter Travel Document Number.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. B.
I used the following travel document to be admitted to the United
States. Enter Country of Issuance for Passport or Travel
Document.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. B.
I used the following travel document to be admitted to the United
States. Enter Date Passport or Travel Document. Enter Date as
2-digit Month, 2-digit Day, and 4-digit Year.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. D.
I obtained Lawful Permanent Resident (L P R) status through
adjustment of status in the United States or admission as a Lawful
Permanent Resident (L P R) (if applicable). Date I became a Lawful
Permanent Resident (L P R). Enter Date as 2-digit Month, 2-digit
Day, and 4-digit Year.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. D.
I obtained Lawful Permanent Resident (L P R) status through
adjustment of status in the United States or admission as a Lawful
Permanent Resident (L P R) (if applicable). Enter U.S. Citizenship
and Immigration Services (U S C I S) Office That Granted My Lawful
Permanent Resident (L P R) Status or Location Where I Was
Admitted.:
Part 2. Information About You. 15. Have you previously
applied for a Certificate of Citizenship or U.S. Passport? Select
this Box for Yes.:
Part 2. Information About You. 16. Have you ever abandoned or
lost your LPR status? Select this Box for Yes.:
Part 2. Information About You. 17. Were you adopted? Select
this Box for Yes. If you answered "Yes" to Item Number 17.,
complete Items. A. - D.:
Part 2. Information About You. 17. Were you adopted? A. Place
of Final Adoption. Enter Country.:
Part 2. Information About You. 18. Did you have to be
re-adopted in the United States? Select this Box for Yes. If you
answered "Yes" to Item Number 18., complete Items. A. - D.:
Part 2. Information About You. 18. Did you have to be
re-adopted in the United States? B. Date of Adoption. Enter Date as
2-digit Month, 2-digit Day, and 4-digit Year.:
Part 2. Information About You. 15. If you answered "Yes" to
Item Number 15., provide an explanation below. If you need extra
space to complete this section, use the space provided in Part 11.
Additional Information.:
Part 2. Information About You. If you answered "Yes" to Item
Number 16., provide an explanation below. If you need extra space
to complete this section, use the space provided in Part 11.
Additional Information.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. C.
My most recent immigration status in the United States was. Select
this Box for A Refugee/Asylee.:
Part 2. Information About You. 14. Information About Your
Admission into the United States and Current Immigration Status. C.
My most recent immigration status in the United States was. Enter
Other Explanation. :
Part 2. Information About You. 17. Were you adopted? A. Place
of Final Adoption. Select State from a List of States.:
Part 2. Information About You. 17. Were you adopted? A. Place
of Final Adoption. Enter City or Town.:
Part 2. Information About You. 18. Did you have to be
re-adopted in the United States? A. Place of Final Adoption. Enter
Country.:
Part 2. Information About You. 18. Did you have to be
re-adopted in the United States? A. Place of Final Adoption. Select
State from a List of States.:
Part 2. Information About You. 18. Did you have to be
re-adopted in the United States? A. Place of Final Adoption. Enter
City or Town.:
Part 2. Information About You. 18. Did you have to be
re-adopted in the United States? C. Date Legal Custody Began. Enter
Date as 2-digit Month, 2-digit Day, and 4-digit Year.:
Part 2. Information About You. 18. Did you have to be
re-adopted in the United States? D. Date Physical Custody Began.
Enter Date as 2-digit Month, 2-digit Day, and 4-digit Year.:
Part 2. Information About You. 17. Were you adopted? C. Date
Legal Custody Began. Enter Date as 2-digit Month, 2-digit Day, and
4-digit Year.:
Part 2. Information About You. 17. Were you adopted? D. Date
Physical Custody Began. Enter Date as 2-digit Month, 2-digit Day,
and 4-digit Year.:
Part 2. Information About You. 17. Were you adopted? B. Date
of Adoption. Enter Date as 2-digit Month, 2-digit Day, and 4-digit
Year.:
Part 2. Information About You. 19. Were your parents married
to each other when you were born (or adopted)? Select this Box for
Yes.:
Part 2. Information About You. 20. Did your parents marry
after you were born? Select this Box for Yes.:
Part 2. Information About You. 21. Do you regularly reside in
the United States in the legal and physical custody of your U.S.
citizen parents, or, if over 18 years of age, did you regularly
reside in the legal and physical custody of your U.S. citizen
parents before turning 18 years of age? Select this Box for
Yes.:
Part 2. Information About You. 22. Have you been absent from
the United States since you first arrived? Complete the following
information only if you are claiming U.S. citizenship at the time
of birth if you were born before October 10, 1952. If you need
extra space to complete this section, use the space provided in
Part 11. Additional Information. A. Date of You Left the United
States. Enter Date as 2-digit Month, 2-digit Day, and 4-digit
Year.:
Part 2. Information About You. 22. Have you been absent from
the United States since you first arrived? Complete the following
information only if you are claiming U.S. citizenship at the time
of birth if you were born before October 10, 1952. If you need
extra space to complete this section, use the space provided in
Part 11. Additional Information. B. Date You Returned to the United
States. Enter Date as 2-digit Month, 2-digit Day, and 4-digit
Year.:
Part 2. Information About You. 22. Have you been absent from
the United States since you first arrived? Complete the following
information only if you are claiming U.S. citizenship at the time
of birth if you were born before October 10, 1952. If you need
extra space to complete this section, use the space provided in
Part 11. Additional Information. D. Date You Left the United
States. Enter Date as 2-digit Month, 2-digit Day, and 4-digit
Year.:
Part 2. Information About You. 22. Have you been absent from
the United States since you first arrived? Complete the following
information only if you are claiming U.S. citizenship at the time
of birth if you were born before October 10, 1952. If you need
extra space to complete this section, use the space provided in
Part 11. Additional Information. E. Date You Returned to the United
States. Enter Date as 2-digit Month, 2-digit Day, and 4-digit
Year.:
Part 3. Biographic Information. 3. Height. Enter Feet.:
Part 3. Biographic Information. 3. Height. Enter Inches.:
Part 3. Biographic Information. 2. Race (Select all applicable
boxes). Select this Box for Asian.:
Part 3. Biographic Information. 1. Ethnicity (Select only one box).
Select this Box for Hispanic or Latino.:
Part 3. Biographic Information. 4. Weight. Enter First Number of
Three Digit Weight in Pounds.:
Part 3. Biographic Information. 4. Weight. Enter Second Number of
Three Digit Weight in Pounds.:
Part 3. Biographic Information. 4. Weight. Enter Third Number of
Three Digit Weight in Pounds.:
Part 3. Biographic Information. 5. Eye color (Select only one box).
Select this Box for Unknown/Other.:
Part 3. Biographic Information. 6. Hair color (Select only one
box). Select this Box for Unknown/Other.:
Part 2. Information About You. 22. Have you been absent from
the United States since you first arrived? Select this Box for
Yes.:
Part 2. Information About You. 22. Have you been absent from
the United States since you first arrived? Complete the following
information only if you are claiming U.S. citizenship at the time
of birth if you were born before October 10, 1952. If you need
extra space to complete this section, use the space provided in
Part 11. Additional Information. F. Place of Entry Upon Return to
the United States. Select State from a List of States.:
Part 2. Information About You. 22. Have you been absent from
the United States since you first arrived? Complete the following
information only if you are claiming U.S. citizenship at the time
of birth if you were born before October 10, 1952. If you need
extra space to complete this section, use the space provided in
Part 11. Additional Information. F. Place of Entry Upon Return to
the United States. Enter City or Town.:
Part 2. Information About You. 22. Have you been absent from
the United States since you first arrived? Complete the following
information only if you are claiming U.S. citizenship at the time
of birth if you were born before October 10, 1952. If you need
extra space to complete this section, use the space provided in
Part 11. Additional Information. C. Place of Entry Upon Return to
the United States. Select State from a List of States.:
Part 2. Information About You. 22. Have you been absent from
the United States since you first arrived? Complete the following
information only if you are claiming U.S. citizenship at the time
of birth if you were born before October 10, 1952. If you need
extra space to complete this section, use the space provided in
Part 11. Additional Information. C. Place of Entry Upon Return to
the United States. Enter City or Town.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 1. Current Legal Name of U.S. Citizen Father.
Enter Middle Name.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 1. Current Legal Name of U.S. Citizen Father.
Enter Given Name (First Name).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). NOTE: Complete this section if you are claiming
citizenship through a U.S. biological father (of adoptive father).
Provide information about yourself if you are a U.S. citizen father
applying for a Certificate of Citizenship on behalf of your minor
biological or adopted child. 1. Current Legal Name of U.S. Citizen
Father. Enter Family Name (Last Name).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 6. My father is a U. S. Citizen by. Birth abroad
to U. S. citizen parents. Alien Registration Number. (A. -Number)
(if any).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 6. My father is a U. S. Citizen by. Select this
Box for Naturalization.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 6. My father is a U. S. Citizen by. Birth abroad
to U. S. citizen parents. Enter Certificate of Citizenship Number
(if any).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 6. My father is a U. S. Citizen by.
Naturalization. Enter. A. -Number. (if any). A.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 6. My father is a U. S. Citizen by.
Naturalization. Enter Certificate of Naturalization Number.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 7. Has your father ever lost U.S. citizenship or
taken any action that would cause loss of U.S. citizenship? Select
this Box for Yes. If you answered “Yes” to Item Number 7., provide
an explanation in Part 11. Additional Information.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 8. Marital History. B. What is your U.S. citizen
father's current marital status? Select this Box for Other.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 8. Marital History. A. How many times have you
been married (including annulled marriages and marriage or
marriages to the same person)? Enter Number of Marriages.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 8. Marital History. B. What is your U.S. citizen
father's current marital status? Other. If you selected "Other,"
provide an explanation. If you need extra space to complete this
section, use the space provided in Part 11. Additional
Information.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 5. Physical Address. Enter City or Town. :
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 5. Physical Address. Select State from a List of
States.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 5. Physical Address. Enter Zip Code Plus 4. Enter
5-digit Zip Code.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 5. Physical Address. Enter Zip Code Plus 4. Enter
4-digit Zip Code Extension.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 5. Physical Address. Enter Apartment, Suite, or
Floor Number.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 5. Physical Address. Select this Box for
Apartment.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 5. Physical Address. Enter Street Number and Name
(Type or print "Deceased" and the date of death if your father has
passed away.) :
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 5. Physical Address. Enter Postal Code (foreign
address only).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 5. Physical Address. Enter Province (foreign
address only).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 5. Physical Address. Enter Country (foreign
address only).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 6. My father is a U. S. Citizen by.
Naturalization. Select State from a List of States.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 6. My father is a U. S. Citizen by.
Naturalization. Enter City or Town. :
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 6. My father is a U. S. Citizen by.
Naturalization. 6. Date of Naturalization (mm/dd/yyyy). :
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 6. My father is a U. S. Citizen by.
Naturalization. Enter Place of Naturalization (Name of Court or U S
C I S Office Location).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 2. Date of Birth (mm/dd/yyyy). Enter Date as
2-digit Month, 2-digit Day, and 4-digit Year.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 3. Enter Country of Birth.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 4. Enter Country of Citizenship or
Nationality.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. F. Enter Date of Marriage as 2-digit Month, 2-digit
Day, and 4-digit Year.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. H. Spouse's Immigration Status. Select this Box for
Other (Explain).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. I. Is your U.S. citizen father's current spouse
also your biological (or adopted) mother? Select this Box for
Yes.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 1. Current Legal Name of U.S. Citizen Mother.
Enter Middle Name.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 1. Current Legal Name of U.S. Citizen Mother.
Enter Given Name (First Name).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). NOTE. Complete this section if you are claiming
citizenship through a U.S. citizen biological mother (or adoptive
mother). Provide information about yourself if you are a U.S.
citizen mother applying for a Certificate of Citizenship on behalf
of your minor biological or adopted child. 1. Current Legal Name of
U.S. Citizen Mother. Enter Family Name (Last Name).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 2. Enter Date of Birth (mm/dd/yyyy) as 2-digit
Month, 2-digit Day, and 4-digit Year.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 3. Enter Country of Birth.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 4. Enter Country of Citizenship or
Nationality.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. H. Spouse's Immigration Status. Other. If you
selected "Other," provide an explanation. If you need extra space
to complete this section, use the space provided in Part 11.
Additional Information.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. D. Enter Country of Citizenship or
Nationality.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. E. Spouse's Physical Address. Enter Street Number
and Name.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. E. Spouse's Physical Address. Enter Apartment,
Suite, or Floor Number.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. E. Spouse's Physical Address. Select this Box for
Apartment.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. E. Spouse's Physical Address. Zip Code Plus 4.
Enter 5-digit Zip Code.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. E. Spouse's Physical Address. Select State from a
List of States.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. E. Spouse's Physical Address. Enter City or
Town.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. E. Spouse's Physical Address. Zip Code Plus 4.
Enter 4-digit Zip Code Extension.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. E. Spouse's Physical Address. Enter Postal Code
(foreign address only).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. E. Spouse's Physical Address. Enter Province
(foreign address only).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. E. Spouse's Physical Address. Enter Country
(foreign address only).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. G. Place of Marriage. Enter Country.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. G. Place of Marriage. Select State from a List of
States.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. G. Place of Marriage. Enter City or Town.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. B. Enter Date of Birth as 2-digit Month, 2-digit
Day, and 4-digit Year.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. C. Enter Country of Birth.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. A. Enter Middle Name.:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. A. Enter Given Name (First Name).:
Part 4. Information About Your U.S. Citizen Biological Father (or
Adoptive Father). 9. Information About U.S. Citizen Father's
Current Spouse. A. Enter Family Name (Last Name).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 7. Has your mother ever lost U.S. citizenship or
taken any action that would cause loss of U.S. citizenship?Select
this Box for Yes. If you answered “Yes” to Item Number 7., provide
an explanation in Part 11. Additional Information.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 8. Marital History. B. What is your current
marital status? Select this Box for Other (Explain).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 8. Marital History. A. How many times has your
U.S. citizen mother been married (including annulled marriages and
marriages to the same person)? Enter Number of Marriages.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 8. Marital History. B. What is your current
marital status? Other (Explain). If you selected “Other,” provide
an explanation. If you need extra space to complete this section,
use the space provided in Part 11. Additional Information.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. A. Enter Middle Name.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. A. Enter Given Name (First Name).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. A. Enter Family Name (Last Name).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 6. My mother is a U. S. Citizen by. Select this
Box for Birth in the United States.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 6. My mother is a U. S. Citizen by.
Naturalization. Enter A. -Number (if any).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 6. My mother is a U. S. Citizen by.
Naturalization. Enter Certificate of Naturalization Number.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 6. My mother is a U. S. Citizen by. Select this
Box for Birth abroad to U. S. citizen parents.A. -Number (if any).
A.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 6. My mother is a U. S. Citizen by. Birth abroad
to U. S. citizen parents. Enter Certificate of Citizenship Number
(if any).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 5. Physical Address. Enter City or Town. :
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 5. Physical Address. Select State from a List of
States.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 5. Physical Address. Zip Code Plus 4. Enter
5-digit Zip Code.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 5. Physical Address. Zip Code Plus 4. Zip Code
Plus 4. Enter 4-digit Zip Code Extension.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 5. Physical Address. Enter Apartment, Suite, or
Floor Number.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 5. Physical Address. Select this Box for
Apartment.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 5. Physical Address. Enter Street Number and Name
(Type or print "Deceased" and the date of death if your mother has
passed away.) :
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 5. Physical Address. Enter Postal Code (foreign
address only).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 5. Physical Address. Enter Province (foreign
address only).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 5. Physical Address. Enter Country (foreign
address only).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 6. My mother is a U. S. Citizen by.
Naturalization. Select State from a List of States.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 6. My mother is a U. S. Citizen by.
Naturalization. Enter City or Town.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. B. Enter Date of Birth as 2-digit Month, 2-digit
Day, and 4-digit Year.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. C. Enter Country of Birth.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 6. My mother is a U. S. Citizen by.
Naturalization. Date of Naturalization (mm/dd/yyyy) as 2-digit
Month, 2-digit Day, and 4-digit Year.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 6. My mother is a U. S. Citizen by.
Naturalization. Enter Place of Naturalization (Name of Court or U S
C I S Office Location).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. I. Is your U.S. citizen mother's current spouse
also your biological (or adopted) father? Select this Box for
Yes.:
Part 6. Physical Presence in the United States From Birth Until
Filing of Form N-600. 1. Indicate whether this information relates
to your U.S. citizen father or mother. Select this Box for U.S.
Citizen Mother.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. H. Spouse's Immigration Status. Select this Box for
Other.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. H. Spouse's Immigration Status. Other. If you
selected “Other,” provide an explanation. If you need extra space
to complete this section, use the space provided in Part 11.
Additional Information.:
Part 7. Information About Military Service of U. S. Citizen
Parents. Dates of Service (mm/dd/yyyy) (If time of service fulfills
any of the required physical presence, submit evidence of the
service.) B. Enter From Date as 2-digit Month, 2-digit Day, and
4-digit Year.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. E. Spouse's Physical Address. Enter Street Number
and Name.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. E. Spouse's Physical Address. Enter Apartment,
Suite, or Floor Number.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. E. Spouse's Physical Address. Select this Box for
Apartment.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. E. Spouse's Physical Address. Zip Code Plus 4.
Enter 5-digit Zip Code.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. E. Spouse's Physical Address. Select State from a
List of States.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. E. Spouse's Physical Address. Enter City or
Town.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. E. Spouse's Physical Address. Zip Code Plus 4.
Enter 4-digit Zip Code Extension.:
Part 4. Information About Your Residence. 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 or sheets of paper.
2. Enter Postal Code (foreign address only).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. E. Spouse's Physical Address. Enter Province
(foreign address only).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. E. Spouse's Physical Address. Enter Country
(foreign address only).:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. D. Enter Country of Citizenship or
Nationality.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. G. Place of Marriage. Select State from a List of
States.:
Part 5. Information About Your U.S. Citizen Biological Mother (or
Adoptive Mother). 9. Information About U.S. Citizen Mother's
Current Spouse. G. Place of Marriage. Enter Country.:
Part 7. Information About Military Service of U. S. Citizen
Parents. NOTE. Complete this only if you are an applicant claiming
U.S. citizenship at time of birth abroad. 1. Has your U.S. citizen
parent served in the U.S. Armed Forces? Select this Box for
Yes.:
Part 7. Information About Military Service of U. S. Citizen
Parents. 2. Select this Box for U.S. Citizen Mother.:
Part 7. Information About Military Service of U. S. Citizen
Parents. 4. Type of Discharge. Select this Box for
Dishonorable.:
Part 8. Applicant's Statement, Contact Information, Certification,
and Signature. Applicant's Statement. NOTE. Select the box for
either Item. A. or B. in Item Number 1. If applicable, select the
box for Item Number 2. 1. Applicant's Statement Regarding the
Interpreter. B. Select this Box for The interpreter named in Part
9. read to me every question and instruction on this application
and my answer to every question, in, a language in which I am
fluent and I understood everything. :
Part 8. Applicant's Statement, Contact Information, Certification,
and Signature. Applicant's Statement. 1. B. Enter language
interpreter used.:
Part 8. Applicant's Statement, Contact Information, Certification,
and Signature. Applicant's Statement. 2. Applicant's Statement
Regarding the Preparer. Select this Box for At my request, the
preparer named in Part 10., prepared this application for me based
only upon information I provided or authorized. :
Part 8. Applicant's Statement, Contact Information, Certification,
and Signature. Applicant's Statement. 2. Applicant's Statement
Regarding the Preparer. Enter the preparer named in Part 10 who
prepared this application.:
Part 8. Applicant's Statement, Contact Information, Certification,
and Signature. Applicant's Contact Information. 5. Enter
Applicant's E-Mail Address (if any).:
Part 8. Applicant's Statement, Contact Information, Certification,
and Signature. Applicant's Contact Information. 3. Enter
Applicant's Daytime Telephone Number.:
Part 8. Applicant's Statement, Contact Information, Certification,
and Signature. Applicant's Contact Information. 4. Enter
Applicant's Mobile Telephone Number (if any).:
Part 8. Applicant's Statement, Contact Information, Certification,
and Signature. Applicant's Signature. 6. Applicant's Signature.
This signature field can not be signed with a digital signature and
the signee's name can not be typewritten into this space. This is a
protected field. Print and sign in ink. If the applicant is a minor
child, the parent must sign the child's name in this space. This
form will be rejected without a signature in this space. NOTE TO
ALL APPLICANTS: If you do not completely fill out this application
or fail to submit required documents listed in the Instructions, U
S C I S may deny your application.:
Part 8. Applicant's Statement, Contact Information, Certification,
and Signature. Applicant's Signature. 6. Date of Signature. Enter
as 2-digit Month, 2-digit Day and 4-digit Year.:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Provide the following information about the interpreter.
Interpreter's Full Name. 2. Enter Interpreter's Business or
Organization Name (if any).:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Provide the following information about the interpreter.
Interpreter's Full Name. 1. Enter Interpreter's Given Name (First
Name).:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Provide the following information about the interpreter.
Interpreter's Full Name. 1. Enter Interpreter's Family Name (Last
Name).:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Interpreter's Mailing Address. 3. Enter City or
Town.:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Interpreter's Mailing Address. 3. Enter Province.:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Interpreter's Mailing Address. 3. Enter Postal
Code.:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Interpreter's Mailing Address. 3. Select State from List
of States.:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Interpreter's Mailing Address. 3. Enter the Street
Number and Name.:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Interpreter's Mailing Address. 3. Select this Box for
Apartment.:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Interpreter's Mailing Address. 3. Enter the number of
Apartment, Suite, or Floor box.:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Interpreter's Mailing Address. 3. Enter Country.:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Interpreter's Mailing Address. 3. Zip Code Plus 4. Enter
5-digit Zip Code.:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Interpreter's Mailing Address. 3. Zip Code Plus 4. Enter
4-digit Zip Code Extension.:
Part 9. Interpreter's Contact Information, Certification, and
Signature. Interpreter's Contact Information. 6. Enter the
Interpreter's E-Mail Address (if any).:
Part 9. Interpreter's Contact Information, Certification, and Si