EFTA00525459.pdf

Application for Naturalization Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form N-400 OMB No. 1615-0052 Expires 03/31/2019 For USCIS Use Only Date Stamp Receipt Action Block Remarks ► START HERE - Type or print in black ink. Type or print "N/A" if an item is not applicable or the answer is none, unless otherwise indicated. Failure to answer all of the questions may delay U.S. Citizenship and Immigration Services (USCIS) processing your Form N400. NOTE: You must complete Parts 1. - 15. If your biological or legal adoptive mother or father is a U.S. citizen by birth, or was naturalized before you reached your 18th birthday, you may already be a U.S. citizen. Before you consider filing this application, please visit the USCIS Website at www.uscis.gov for more information on this topic and to review the instructions for Form N-600, Application for Certificate of Citizenship, and Form N-600K. Application for Citizenship and Issuance of Certificate Under Section 322. NOTE: Are either of your parents a United States citizen? If you answer "Yes," then complete Part 6. Information About Your Parents as part of this application. If you answer "No," then skip Part 6. and go to Part 7. Biographic Information. Part 1. Information About Your Eligibility (Select only one box or your Form N-400 may be delayed) 1. You are at least 18 years of age and: A. 0 B. K C. K Have been a lawful permanent resident of the United States for at least 5 years. Have been a lawful permanent resident of the United States for at least 3 years. In addition, you have been married to and living with the same U.S. citizen spouse for the last 3 years, and your spouse has been a U.S. citizen for the last 3 years at the time you filed your Form N-400. Are a lawful permanent resident of the United States and you are the spouse of a U.S. citizen and your U.S. citizen spouse is regularly engaged in specified employment abroad. (See the Immigration and Nationality Act (INA) section 319(b).) If your residential address is outside the United States and you are filing under Section 319(b), select the USCIS Field Office from the list below where you would like to have your naturalization interview: Enter Your 9 Digit A-Number: ► A- j D. K Are applying on the basis of qualifying military service. E. K Other (Explain): Part 2. Information About You (Person applying for naturalization) I. 2. Your Current Legal Name (do not provide a nickname) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Your Name Exactly As It Appears on Your Permanent Resident Card (if applicable) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Fonn N-400 12/23/16 N Page I of 20 EFTA00525459 Part 2. Information About You (Person applying for naturalization) (continued) A- 3. Other Names You Have Used Since Birth (include nicknames, aliases, and maiden name, if applicable) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 4. Name Change (Optional) Read the Form N-400 Instructions before you decide whether or not you would like to legally change your name. Would you like to legally change your name? If you answered "Yes," type or print the new name you would like to use in the spaces provided below. Family Name (Last Name) O Yes O No Given Name (First Name) Middle Name (if applicable) _J 5. U.S. Social Security Number (if applicable) 6. USCIS Online Account Number (if any) ► 7. Gender El Male I] Female 10. Country of Birth 8. Date of Birth (mm/ddiy_yyy) 9. Date You Became a Lawful Permanent Resident (mm/dd/yyyy) 11. Country of Citizenship or Nationality 12. Do you have a physical or developmental disability or mental impairment that prevents you from demonstrating your knowledge and understanding of the English language and/or civics requirements for naturalization? O Yes O No If you answered "Yes," submit a completed Form N-648, Medical Certification for Disability Exceptions, when you file your Form N-400. 13. Exemptions from the English Language Test A. Are you 50 years of age or older and have you lived in the United States as a lawful permanent resident for periods totaling at least 20 years at the time you file your Form N-400? B. Are you 55 years of age or older and have you lived in the United States as a lawful permanent resident for periods totaling at least 15 years at the time you file your Form N-400? C. Are you 65 years of age or older and have you lived in the United States as a lawful permanent resident for periods totaling at least 20 years at the time you file your Form N400? (If you meet this requirement, you will also be given a simplified version of the civics test.) O Yes O No O Yes O No O Yes O No Part 3. Accommodations for Individuals With Disabilities and/or Impairments NOTE: Read the information in the Form N-400 Instructions before completing this part. 1. Are you requesting an accommodation because of your disabilities and/or impairments? If you answered "Yes," select any applicable box. A. O I am deaf or hard of hearing and request the following accommodation. (If you are requesting a sign-language interpreter, indicate for which language (for example, American Sign Language).) O Yes O No B. El I am blind or have low vision and request the following accommodation: Fonn N-400 12/23/16 N Page 2 of 20 EFTA00525460 Part 3. Accommodations for Individuals With Disabilities and/or Impairments (continued) A- C. K I have another type of disability and/or impairment (for example, use a wheelchair). (Describe the nature of your disability and/or impairment and the accommodation you are requesting.) Part 4. Information to Contact You 1. 3. 5. Daytime Telephone Number 2. 4. Work Telephone Number (if any) Evening Telephone Number Mobile Telephone Number (if any) Email Address (if any) Part 5. Information About Your Residence 1. Where have you lived during the last five years? Provide your most recent residence and then list every location where you have lived during the last five years. If you need extra space, use additional sheets of paper. A. Current Physical Address Street Number and Name Apt. Ste. Flr. ZIP Code Number City or Town County State + 4 Province or Region (foreign address only) Postal Code Country (foreign address only) (foreign address only) Dates of From (mm/dd/yyyy) To (mm/dd/yyyy) Residence B. Current Mailing Address (if different from the address above) In Care Of Name (if any) Street Number and Name Apt. Ste. Flr. K K K ZIP Code Number City or Town County State + 4 Province or Region (foreign address only) Postal Code (foreign address only) Country (foreign address only) Fonn N-400 12/23/16 N Page 3 of 20 EFTA00525461 Part 5. Information About Your Residence (continued) C. Physical Address 2 Street Number and Name A- City or Town Province or Region (foreign address only) Dates of Residence From (mm/dd/yyyy) County Postal Code (foreign address only) To (mm/dd/yyyy) State Apt. Ste. Flr. Number ZIP Code + 4 Country (foreign address only) D. Physical Address 3 Street Number and Name City or Town Province or Region (foreign address only) Dates of Residence From (mm/dd/yyyy) County Postal Code (foreign address only) To (mm/dd/yyyy) State Apt. Ste. Flr. Number ZIP Code + 4 Country (foreign address only) E. Physical Address 4 Street Number and Name Apt. Ste. Flr. Number City or Town Province or Region (foreign address only) Dates of Residence From (mm/dd/yyyy) County Postal Code (foreign address only) To (mm/dd/yyyy) r State Country (foreign address only) ZIP Code + 4 Part 6. Information About Your Parents If neither one of your parents is a United States citizen, then skip this part and go to Part 7. 1. Were your parents married before your 18th birthday? Information About Your Mother 2. Is your mother a U.S. citizen? If you answered "Yes," complete the following information. If you answered "No," go to Item Number 3. K Yes K No K Yes K No Fonn N-400 12/23/16 N Page 4 of 20 EFTA00525462 Part 6. Information About Your Parents (continued) A- A. B. D. Current Legal Name of U.S. Citizen Mother Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Mother's Country of Birth C. A-Number Mother's Date of Birth (mm/dcVyyyy) Date Mother Became a U.S. Citizen E. (if known) (mm/dd/yyyy) Mothers (if any) ► A- Information About Your Father 3. Is your father a U.S. citizen? If you answered "Yes," complete the information below. If you answered "No," go to Part 7. A. Current Legal Name of U.S. Citizen Father Family Name (Last Name) J B. Father's Country of Birth Given Name (First Name) K Yes K No Middle Name (if applicable) C. Father's Date of Birth (mm/dd/yyyy) D. Date Father Became a U.S. Citizen E. Father's A-Number (if known) (mm/dd/yyyy) (if any) ► A- I Part 7. Biographic Information NOTE: USCIS requires you to complete the categories below to conduct background checks. (See the Form N-400 Instructions for more information.) 1. 2. Ethnicity (Select only one box) K Hispanic or Latino K Not Hispanic or Latino Race (Select all applicable boxes) K White K Asian K Black or African K American Indian American or Alaska Native K Native Hawaiian or Other Pacific Islander 3. Height Feet Inches 4. Weight Pounds 5. Eye color (Select only one box) 6. K Black K Blue K Brown K Gray K Green K Hazel Hair color (Select only one box) K Maroon K Pink K Unknown/ Other K Bald K Black K Blond K Brown K Gray K Red (No hair) K Sandy K White K Unknown/ Other Fonn N-400 12/23/16 N Page 5 of 20 EFTA00525463 Part 8. Information About Your Employment and Schools You Attended A- List where you have worked or attended school full time or part time during the last five years. Provide information for the complete time period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were unemployed, or have studied for the last five years. If you worked for yourself, type or print "self-employed." If you were unemployed, type or print "unemployed." If you need extra space, use additional sheets of paper. 1. Employer or School Name Street Number and Name Apt. Ste. Flr. ZIP Code Number City or Town State + 4 Province or Region Postal Code Country (foreign address only) (foreign address only) (foreign address only) Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Your Occupation 2. Employer or School Name Street Number and Name Apt. Ste. Flr. ZIP Code Number City or Town State + 4 Province or Region Postal Code Country (foreign address only) (foreign address only) (foreign address only) Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Your Occupation 3. Employer or School Name Street Number and Name Apt. Ste. Flr. K K K ZIP Code Number City or Town State + 4 Province or Region Postal Code Country (foreign address only) (foreign address only) (foreign address only) Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Your Occupation Fonn N-400 12/23/16 N Page 6 of 20 EFTA00525464 Part 9. Time Outside the United States A- 1. How many total days (24 hours or longer) did you spend outside the United States during the last 5 years? 2. How many trips of 24 hours or longer have you taken outside the United States during the last 5 years? days trips 3. List below all the trips of 24 hours or longer that you have taken outside the United States during the last 5 years. Start with your most recent trip and work backwards. If you need extra space. use additional sheets of paper. Date You Lett the United States (mm/dd/yyyy) Date You Returned to the United States (mm/dd/yyyy) Did Trip Last 6 Months or More? Countries to Which You Traveled Total Days Outside the United States O Yes O No O Yes O No O Yes O No O Yes O No K Yes O No K Yes O No Part 10. Information About Your Marital History 1. What is your current marital status? K Single, Never Married K Married K Divorced K Widowed K Separated K Marriage Annulled If you are single and have never married, go to Part 11. 2. If you are married, is your spouse a current member of the U.S. armed forces? 3. How many times have you been married (including annulled marriages, marriages to other people, and marriages to the same person)? 4. If you are married now, provide the following information about your current spouse. K Yes K No A. B. C. D. Current Spouse's Legal Name Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Current Spouse's Previous Legal Name Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Other Names Used by Current Spouse (include nicknames, aliases, and maiden name, if appl cable) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Current Spouse's Date of Birth E. Date You Entered into Marriage (mm/dd/yyyy) with Current Spouse (mm/dd/yyyy) Fonn N-400 12/23/16 N Page 7 of 20 EFTA00525465 Part 10. Information About Your Marital History (continued) F. Current Spouse's Present Home Address Street Number and Name City or Town Province or Region (foreign address only) A- County Postal Code (foreign address only) G. Current Spouse's Current Employer or Company State Apt. Ste. Fir. Number K K K Country (foreign address only) ZIP Code + 4 5. Is your current spouse a U.S. citizen? If you answered "Yes," answer Item Number 6. If you answered "No," go to Item Number 7. 6. If your current spouse is a U.S. citizen, complete the following information. A. When did your current spouse become a U.S. citizen? K At Birth - Go to Item Number 8. K Other - Complete the following information. B. Date Your Current Spouse Became a U.S. Citizen (mm/dd/yyyy) 7. If your current spouse is not a U.S. citizen, complete the following information. A. Current Spouse's Country of Citizenship or Nationality B. Current Spouse's A-Number (if any) ► A- C. Current Spouse's Immigration Status K Lawful Permanent Resident K Other (Explain): 8. How many times has your current spouse been married (including annulled marriages, marriages to other people, and marriages to the same person)? If your current spouse has been married before, provide the following information about your current spouse's prior spouse. If your current spouse has had more than one previous marriage, provide that information on additional sheets of paper. A. Legal Name of My Current Spouse's Prior Spouse Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) B. Immigration Status of My Current Spouse's Pnor Spouse (if known) K U.S. Citizen K Lawful Permanent Resident K Other (Explain): C. Date of Birth of My Current Spouse's D. Country of Birth of My Current Spouse's Prior Spouse (mm/dd/yyyy) Prior Spouse E. of My Country of Citizenship or Nationality Current Spouse's Prior Spouse K Yes K No Fonn N-400 12/23/16 N Page 8 of 20 EFTA00525466 Part 10. Information About Your Marital History (continued) A- F. My Current Spouse's Date of Marriage with Prior Spouse (mm/dd/yyyy) G. Date My Current Spouse's Marriage with Prior Spouse (mm/dd/yyyy) Ended H. Ended with How My Current Spouse's Marriage Prior Spouse K Annulled K Divorced K Spouse Deceased K Other (Explain): 9. If you were married before, provide the following information about your prior spouse. If you have more than one previous marriage, provide that information on additional sheets of paper. A. My Prior Spouse's Legal Name Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) B. My Prior Spouse's Immigration Status When My Marriage Ended (if known) K U.S. Citizen K Lawful Permanent Resident K Other (Explain): C. My Prior Spouse's Date of Birth D. My Prior Spouse's Country (mm/dd/yyyy) of Birth E. My Prior Spouse's Country of F. Date of Marriage with My Prior Citizenship or Nationality Spouse (mm/dd/yyyy) G. Date Marriage Ended with My Prior Spouse (mm/dd/yyyy) H. Spouse How Marriage Ended with My Prior K Annulled K Divorced K Spouse Deceased K Other (Explain): Part 11. Information About Your Children 1. Indicate your total number of children. (You must indicate ALL children, including: children who are alive, missing, or deceased: children born in the United States or in other countries; children under 18 years of age or older; children who are currently married or unmarried; children living with you or elsewhere; current stepchildren; legally adopted children; and children born when you were not married.) 2. Provide the following information about all your children (sons and daughters) listed in Item Number 1., regardless of age. To list any additional children, use additional sheets of paper. A. Child I Current Legal Name Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) A-Number (if any) Date of Birth (mm/dd/yyyy) Country of Birth ► A- Fonn N-400 12/23/16 N Page 9 of 20 EFTA00525467 Part 11. Information About Your Children (continued) Current Address Street Number and Name A- Apt. Ste. Flr. Number K K K City or Town Province or Region (foreign address only) County Postal Code (foreign address only) What is your child's relationship to you? (for example, biological child, stepchild, legally adopted child) State Country (foreign address only) ZIP Code + 4 B. Child 2 Current Legal Name Family Name (Last Name) A-Number (if any) ► A- Current Address Street Number and Name Given Name (First Name) Date of Birth (mmald/yyyy) Country of Birth Middle Name (if applicable) Apt. Ste. Flr. Number City or Town Province or Region (foreign address only) County L Postal Code (foreign address only) What is your child's relationship to you? (for example, biological child, stepchild, legally adopted child) State Country (foreign address only) ZIP Code + 4 C. Child 3 Current Legal Name Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) A-Number (if any) Date of Birth (nunidd/yyyy) Country of Birth ► A- Fonn N-400 12/23/16 N Page 10 of 20 EFTA00525468 Part 11. Information About Your Children (continued) A- Current Address Street Number and Name Apt. Ste. Flr. ZIP Code Number City or Town County State + 4 Province or Region (foreign address only) Postal Code (foreign address only) Country (foreign address only) What is your child's relationship to you? (for example, biological child, stepchild, legally adopted child) D. Child 4 Current Legal Name Family Name (Last Name) A-Number (if any) ► A- Given Name (First Name) Date of Birth (mmidd/yyyy) Country of Birth Middle Name (if applicable) Current Address Street Number and Name City or Town County State Province or Region (foreign address only) Postal Code (foreign address only) Country (foreign address only) What is your child's relationship to you? (for example, biological child, stepchild. legally adopted child) Apt. Ste. Flr. Number ZIP Code + 4 Part 12. Additional Information About You (Person Applying for Naturalization) Answer Item Numbers I. - 21. If you answer "Yes" to any of these questions, include a typed or printed explanation on additional sheets of paper. 1. Have you EVER claimed to be a U.S. citizen (in writing or any other way)? K Yes K No 2. Have you EVER registered to vote in any Federal, state, or local election in the United States? K Yes K No 3. Have you EVER voted in any Federal, state, or local election in the United States? K Yes K No 4. A. Do you now have, or did you EVER have, a hereditary title or an order of nobility in any foreign K Yes K No country? B. If you answered "Yes," are you willing to give up any inherited titles or orders of nobility that you K Yes K No have in a foreign country at your naturalization ceremony? 5. Have you EVER been declared legally incompetent or been confined to a mental institution? K Yes K No Fonn N-400 12/23/16 N Page II of 20 EFTA00525469 Part 12. Additional Information About You (Person Applying for Naturalization) (continued) 6. Do you owe any overdue Federal, state, or local taxes? A- 7. A. Have you EVER not filed a Federal, state, or local tax return since you became a lawful permanent resident? B. If you answered "Yes," did you consider yourself to be a "non-U.S. resident"? 8. Have you called yourself a "non-U.S. resident" on a Federal, state, or local tax return since you became a lawful permanent resident? K Yes K Yes K Yes K Yes No No No No 9. A. Have you EVER been a member of, involved in, or in any way associated with, any organization, K Yes K No association, fund, foundation, party, club, society, or similar group in the United States or in any other location in the world? B. If you answered "Yes," provide the information below. If you need extra space, attach the names of the other groups on additional sheets of paper and provide any evidence to support your answers. Name of the Group Purpose of the Group Dates of Membership From (mmiddiyyvy) To (mmiddiyyvy) 10. Have you EVER been a member of, or in any way associated (either directly or indirectly) with A. The Communist Party? B. Any other totalitarian party? C. A terrorist organization? 11. Have you EVER advocated (either directly or indirectly) the overthrow of any government by force or violence? K Yes K No K Yes K No K Yes K No K Yes K No 12. Have you EVER persecuted (either directly or indirectly) any person because of race, religion, national K Yes K No origin, membership in a particular social group, or political opinion? 13. Between March 23, 1933 and May 8, 1945, did you work for or associate in any way (either directly or indirectly) with: A. The Nazi government of Germany? B. Any government in any area occupied by, allied with, or established with the help of the Nazi government of Germany? C. Any German, Nazi, or S.S. military unit, paramilitary unit, self-defense unit, vigilante unit, citizen unit, police unit, government agency or office, extermination camp. concentration camp, prisoner of war camp, prison, labor camp, or transit camp? Yes Yes Yes No No No Fonn N-400 12/23/16 N Page 12 of 20 EFTA00525470 Part 12. Additional Information About You (Person Applying for Naturalization) (continued) 14. Were you EVER involved in any way with any of the following: A. Genocide? B. Torture? C. Killing, or trying to kill, someone? D. Badly hurting, or frying to hurt, a person on purpose? E. Forcing, or trying to force, someone to have any kind of sexual contact or relations? F. Not letting someone practice his or her religion? A- 15. Were you EVER a member of, or did you EVER serve in. help, or otherwise participate in, any of the following groups: A. Military unit? B. Paramilitary unit (a group of people who act like a military group but are not part of the official military)? C. Police unit? D. Self-defense unit? E. Vigilante unit (a group of people who act like the police, but are not part of the official police)? F. Rebel group? G. Guerrilla group (a group of people who use weapons against or otherwise physically attack the military, police, government, or other people)? H. Militia (an army of people, not part of the official military)? I. Insurgent organization (a group that uses weapons and fights against a government)? 16. Were you EVER a worker, volunteer, or soldier, or did you otherwise EVER serve in any of the following: A. Prison or jail? B. Prison camp? C. Detention facility (a place where people are forced to stay)? D. Labor camp (a place where people are forced to work)? E. Any other place where people were forced to stay? 17. Were you EVER a part of any group, or did you EVER help any group, unit, or organization that used a weapon against any person. or threatened to do so? A. If you answered "Yes," when you were part of this group, or when you helped this group, did you ever use a weapon against another person? B. If you answered "Yes," when you were part of this group, or when you helped this group, did you ever tell another person that you would use a weapon against that person? 18. Did you EVER sell, give, or provide weapons to any person, or help another person sell, give, or provide weapons to any person? A. If you answered "Yes," did you know that this person was going to use the weapons against another person? B. If you answered "Yes," did you know that this person was going to sell or give the weapons to someone who was going to use them against another person? K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No Fonn N-400 12/23/16 N Page 13 of 20 EFTA00525471 Part 12. Additional Information About You (Person Applying for Naturalization) (continued) 19. Did you EVER receive any type of military. paramilitary (a group of people who act like a mi itary group K Yes K No but are not part of the official military), or weapons training? 20. Did you EVER recruit (ask), enlist (sign up), conscript (require), or use any person under IS years of age K Yes K No to serve in or help an armed force or group? 21. Did you EVER use any person under IS years of age to do anything that helped or supported people in K Yes K No combat? If any of Item Numbers 22. - 28. apply to you, you must answer "Yes" even if your records have been sealed, expunged, or otherwise cleared. You must disclose this information even if someone, including a judge, law enforcement officer, or attorney, told you that it no longer constitutes a record or told you that you do not have to disclose the information. 22. Have you EVER committed, assisted in committing, or attempted to commit, a crime or offense for which K Yes K No you were NOT arrested? 23. Have you EVER been arrested, cited, or detained by any law enforcement officer (including any K Yes K No immigration official or any official of the U.S. armed forces) for any reason? 24. Have you EVER been charged with committing, attempting to commit, or assisting in committing a crime K Yes K No or offense? 25. Have you EVER been convicted of a crime or offense? 26. Have you EVER been placed in an alternative sentencing or a rehabilitative program (for example, diversion, deferred prosecution, withheld adjudication, deferred adjudication)? 27. A. Have you EVER received a suspended sentence, been placed on probation, or been paroled? B. If you answered "Yes," have you completed the probation or parole? 28. A. Have you EVER been in jail or prison? B. If you answered "Yes," how long were you in jail or prison? Years Months K Yes K No K Yes K No K Yes K Yes K Yes Days No No No 29. If you answered "No" to ALL questions in Item Numbers 23. - 28.. then skip this item and go to Item Number 30. If you answered "Yes" to any question in Item Numbers D.- 28.. then complete this table. If you need extra space, use additional sheets of paper and provide any evidence to support your answers. Why were you arrested, cited, detained, or charged? Date arrested, cited, detained, or charged. (mmiddiyyyy) Where were you arrested, cited, detained, or charged? (City or Town. State. Country) Outcome or disposition of the arrest, citation, detention, or charge (no charges filed, charges dismissed, jail. probation. etc.) Fonn N-400 12/23/16 N Page 14 of 20 EFTA00525472 Part 12. Additional Information About You (Person Applying for Naturalization) (continued) A- Answer Item Numbers 30. - 46. If you answer "Yes" to any of these questions, except Item Numbers 37. and 38.. include a typed or printed explanation on additional sheets of paper and provide any evidence to support your answers. 30. Have you EVER: A. B. C. D. E. F. G. H. I. Been a habitual drunkard? Been a prostitute, or procured anyone for prostitution? Sold or smuggled controlled substances, illegal drugs, or narcotics? Been married to more than one person at the same time? Married someone in order to obtain an immigration benefit? Helped anyone to enter, or try to enter, the United States illegally? Gambled illegally or received income from illegal gambling? Failed to support your dependents or to pay alimony? Made any misrepresentation to obtain any public benefit in the United States? 31. Have you EVER given any U.S. Government officials any information or documentation that was false. fraudulent, or misleading? 32. Have you EVER lied to any U.S. Government officials to gain entry or admission into the United States or to gain immigration benefits while in the United States? 33. Have you EVER been removed, excluded, or deported from the United States? 34. Have you EVER been ordered removed, excluded, or deported from the United States? 35. Have you EVER been placed in removal, exclusion, rescission, or deportation proceedings? 36. Are removal, exclusion, rescission, or deportation proceedings (including administratively closed proceedings) currently pending against you? 37. Have you EVER served in the U.S. armed forces? 38. A. Are you currently a member of the U.S. armed forces? B. If you answered "Yes," are you scheduled to deploy overseas, including to a vessel, within the next three months? (Refer to the Address Change section in the Instructions on how to notify USCIS if you learn of your deployment plans after you file your Form N-400.) C. If you answered "Yes," are you currently stationed overseas? 39. Have you EVER been court-martialed, administratively separated, or disciplined, or have you received an other than honorable discharge, while in the U.S. armed forces? 40. Have you EVER been discharged from training or service in the U.S. armed forces because you were an alien? 41. Have you EVER left the United States to avoid being drafted in the U.S. armed forces? 42. Have you EVER applied for any kind of exemption from military service in the U.S. armed forces? 43. Have you EVER deserted from the U.S. armed forces? K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No Fonn N-400 12/23/16 N Page 15 of 20 EFTA00525473 Part 12. Additional Information About You (Person Applying for Naturalization) (continued) A- 44. A. Are you a male who lived in the United States at any time between your 18th and 26th birthdays? K Yes K No (This does not include living in the United States as a lawful nonimmigrant.) B. If you answered "Yes," when did you register for the Selective Service? Provide the information below. Date Registered Selective Service (mm/dd/yyyy) Number C. If you answered "Yes," but you did not register with the Selective Service System and you are: I. Still under 26 years of age, you must register before you apply for naturalization, and complete the Selective Service information above; OR 2. Now 26 to 31 years of age (29 years of age if you are filing under INA section 319(a)), but you did not register with the Selective Service, you must attach a statement explaining why you did not register, and provide a status information letter from the Selective Service. Answer Item Numbers 45. - 50. If you answer "No" to any of these questions, include a typed or printed explanation on additional sheets of paper and provide any evidence to support your answers. 45. Do you support the Constitution and form of Government of the United States? K Yes K No 46. Do you understand the full Oath of Allegiance to the United States? K Yes K No 47. Are you willing to take the full Oath of Allegiance to the United States? K Yes K No 48. If the law requires it, are you willing to bear arms on behalf of the United States? K Yes K No 49. If the law requires it, are you willing to perform noncombatant services in the U.S. armed forces? K Yes K No 50. If the law requires it, are you willing to perform work of national importance under civilian direction? K Yes K No Part 13. Applicant's Statement, Certification, and Signature NOTE: Read the Penalties section of the Form N-400 Instructions before completing this part. 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 A. ❑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. B. K The interpreter named in Part 14. 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. 2. Applicant's Statement Regarding the Preparer K At my request, the preparer named in Part 15., prepared this application for me based only upon information I provided or authorized. Fonn N-400 12/23/16 N Page 16 of 20 EFTA00525474 Part 13. Applicant's Statement, Certification, and Signature (continued) I A- Applicant's Certification Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek. I further authorize release of information contained in this application, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws. I understand that USCIS will require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, I will be required to sign an oath reaffirming that: 1) I reviewed and provided or authorized all of the information in my 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. 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. Applicant's Signature 3. Applicant's Signature 4 Date of Signature (mm/dd/yyyy) NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submi required documents listed in the Instructions. USCIS may deny your application. Part 14. Interpreter's Contact Information, Certification, and Signature Provide the following information about the interpreter. Interpreter's Full Name 1. Interpreter's Family Name (Last Name) 2. Interpreter's Business or Organization Name (if any) Interpreter's Mailing Address 3. Street Number and Name Interpreter's Given Name (First Name) City or Town Province Postal Code Country Apt. Ste. Flr. State Number ZIP Code + 4 Fonn N-400 12/23/16 N Page 17 of 20 EFTA00525475 Part 14. Interpreter's Contact Information, Certification, and Signature (continued) Interpreter's Contact Information 4. Interpreter's Daytime Telephone Number 6. Interpreter's Email Address (if any) Interpreter's Certification I certify, under penalty of perjury, that: A- 5. Interpreter's Mobile Telephone Number (if any) I am fluent in English and I , which is the same language specified in Part 13., Item B. in Item Number 1., and I have read to this applicant in the identified language every question and instruction on this application and his or her answer to every question. The applicant informed me that he or she understands every instruction, question and answer on the application, including the Applicant's Certification and has verified the accuracy of every answer. Interpreter's Signature 7. Interpreter's Signature 4 Date of Signature (mm/dd/yyyy) Part 15. Contact Information, Declaration, and Signature of the Person Preparing This Application, if Other Than the Applicant Provide the following information about the preparer. Preparer's Full Name 1. Preparer's Family Name (Last Name) 2. Preparer's Business or Organization Name (if any) Preparer's Mailing Address 3. Street Number and Name Preparer's Given Name (First Name) City or Town Province Postal Code Country Apt. Ste. Flr. State Number ZIP Code + 4 Fonn N-400 12/23/16 N Page IS of 20 EFTA00525476 Part 15. Contact Information, Declaration, and Signature of the Person Preparing This Application, if Other Than the Applicant (continued) Preparer's Contact Information 4. Preparer's Daytime Telephone Number 6. Preparer's Email Address (if any) A- 5. Preparer's Mobile Telephone Number (if any) Preparer's Statement 7. A. K I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent. B. K I am an attorney or accredited representative and my representation of the applicant in this case K extends K does not extend beyond the preparation of this application. NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this application, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application. Preparer's Certification By my signature. I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted with, his or her application, including the Applicant's Certification, and that all of this information is complete, true, and correct. I completed this application based only on information that the applicant provided to me or authorized me to obtain or use. Preparer's Signature 8. Preparer's Signature Date of Signature (mmidd/yyyy) NOTE: Do not complete Parts 16., 17., or 18. until the USCIS Officer instructs you to do so at the interview. Part 16. Signature at Interview I swear (affirm) and certify under penalty of perjury under the laws of the United States of America that I know that the contents of this Form N-400, Application for Naturalization, subscribed by me, including corrections number 1 through complete, true, and correct. The evidence submitted by me on numbered pages I through are complete, true, and correct. ,are Subscribed to and sworn to (affirmed) before me USCIS Officer's Printed Name or Stamp Applicant's Signature Date of Signature (mmtddiyyyy) USCIS Officer's Signature Fonn N-400 12/23/16 N Page 19 of 20 EFTA00525477 Part 17. Renunciation of Foreign Titles A- If you answered "Yes" to Part 12., Items A. and B. in Item Number 4., then you must affirm the following before a USCIS officer: I further renounce the title of which I have heretofore held; or to which I have heretofore belonged. I further renounce the order of nobility of Applicant's Printed Name (list titles) (list order of nobility) Applicant's Signature USCIS Officer's Printed Name USCIS offices Signature Date of Signature (mm/dd/yyyy) Part 18. Oath of Allegiance If your application is approved, you will be scheduled for a public oath ceremony at which time you will be required to take the following Oath of Allegiance immediately prior to becoming a naturalized citizen. By signing below you acknowledge your willingness and ability to take this oath: I hereby declare on oath, that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince, potentate, state, or sovereignty, of whom or which I have heretofore been a subject or citizen; that I will support and defend the Constitution and laws of the United States of America against all enemies, foreign, and domestic; that I will bear true faith and allegiance to the same; that I will bear arms on behalf of the United States when required by the law; that I will perform noncombatant service in the armed forces of the United States when required by the law; that I will perform work of national importance under civilian direction when required by the law; and that I take this obligation freely, without any mental reservation or purpose of evasion; so help me God. Applicant's Printed Name Family Name (Last Name) Applicant's Signature Given Name (First Name) Middle Name (if applicable) Date of Signature (mm/dd/yyyy) Fonn N-400 12/23/16 N Page 20 of 20 EFTA00525478