Blank USCIS N-400 Form

Date Stamp

For

USCIS

Use

Only

Remarks

Receipt

Action Block

Part 1. Information About Your Eligibility (Select only one box to identify the basis of your eligibility or your Form N-400 may be delayed or rejected.)

Enter Your 9 Digit A-Number:

► A-

A.

B.

C.

D.

E.

F.

General Provision. See Instructions: List of General Eligibility Requirements

Spouse of U.S. Citizen. See Instructions: Eligibility Based on Marriage to a U.S. Citizen

VAWA. See Instructions: Eligibility for the Spouse, Former Spouse, or Child of a U.S. Citizen under the Violence

Against Women Act (VAWA)

Spouse of U.S. Citizen in Qualified Employment Outside the United States. See Instructions: Eligibility for the

Spouse of a U.S. Citizen Working for a Qualified Employer Outside the United States

If your residential address is outside the United States and you are filing under Immigration and Nationality Act (INA) section 319(b), select the USCIS field office where you would like to have your naturalization interview. You can find a USCIS field office at www.uscis.gov/field-offices.

Military Service During Period of Hostilities. See Instructions: Eligibility and Evidence for Current and Former

Members of the U.S. Armed Forces

At Least One Year of Honorable Military Service at Any Time. See Instructions: Eligibility and Evidence for

Current and Former Members of the U.S. Armed Forces

G.

Other Reason for Filing Not Listed Above

Part 2. Information About You (Person applying for naturalization) (continued)

A-

Family Name (Last Name)

4.USCIS Online Account Number (if any)

►

6.Date of Birth (mm/dd/yyyy)

5.Sex

Male Female

10.Was your mother or father (including adoptive mother or father) a U.S. citizen before your 18th birthday?

Yes

No

11.Do you have a physical or developmental disability or mental impairment that prevents you from demonstrating your knowledge and understanding of the English language or civics requirements for naturalization?

Yes

No

Part 3. Biographic Information

A-

Hispanic or Latino

Not Hispanic or Latino

2.Race (Select all applicable boxes)

5.Eye color (Select only one box)

6.Hair color (Select only one box)

White

Pink

White

Unknown/ Other

Unknown/ Other

Current Physical Address In Care Of Name (if any)

Street Number and Name

City or Town

Apt. Ste. Flr. Number

Dates of Residence: From (mm/dd/yyyy)

Dates of Residence: To (mm/dd/yyyy)

PRESENT

Physical Address

(Street Number and Name)

City or Town

Dates of Residence

From To

(mm/dd/yyyy) (mm/dd/yyyy)

Part 4. Information About Your Residence (continued)

3.Current Mailing Address (Safe Mailing Address, if applicable) In Care Of Name (if any)

A-

If you are single and have never married, go to Part 6. Information About Your Children.

2.If you are currently married, is your spouse a current member of the U.S. armed forces?

Marriage Annulled

Yes

No

Part 5. Information About Your Marital History (continued)

A-

Part 8. Time Outside the United States

A-

Date You Left the

United States (mm/dd/yyyy)

Date You Returned to the United States (mm/dd/yyyy)

Countries to Which You Traveled

1.Have you EVER claimed to be a U.S. citizen (in writing or any other way)?

2.Have you EVER registered to vote or voted in any Federal, state, or local election in the United States? If you lawfully voted only in a local election where aliens are eligible to vote, you may answer “No.”

Yes Yes

No No

3.Do you currently owe any overdue Federal, state, or local taxes in the United States?

4.Since you became a lawful permanent resident, have you called yourself a “nonresident alien” on a Federal, state, or local tax return or decided not to file a tax return because you considered yourself to be a nonresident?

Have you EVER:

5.a. Been a member of, involved in, or in any way associated with any Communist or totalitarian party anywhere in the world?

Yes Yes

Yes

No No

No

5.b. Advocated (supported and promoted) any of the following, or been a member of, involved in, or in any way associated with any group anywhere in the world that advocated any of the following:

Opposition to all organized government;

World communism;

The establishment in the United States of a totalitarian dictatorship;

The overthrow by force or violence or other unconstitutional means of the Government of the United States or all forms of law;

The unlawful assaulting or killing of any officer or officers of the Government of the United States or of any other organized government because of their official character;

The unlawful damage, injury, or destruction of property; or Sabotage?

Yes

No

Part 9. Additional Information About You (continued)

A-

Have you EVER been a member of, involved in, or in any way associated with, or have you EVER provided money, a thing of value, services or labor, or any other assistance or support to a group that:

No No

No

7.a. Torture?

7.b. Genocide?

7.c. Killing or trying to kill any person?

7.d. Intentionally and severely injuring or trying to injure any person?

7.e. Any kind of sexual contact or activity with any person who did not consent (did not agree) or was unable to consent (could not agree), or was being forced or threatened by you or by someone else?

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

7.f. Not letting someone practice his or her religion?

7.g. Causing harm or suffering to any person because of his or her race, religion, national origin, membership in a particular social group, or political opinion?

8.a. Have you EVER served in, been a member of, assisted (helped), or participated in any military or police unit?

8.b. Have you EVER served in, been a member of, assisted (helped), or participated in any armed group (a group that carries weapons), for example: paramilitary unit (a group of people who act like a military group but are not part of the official military), self-defense unit, vigilante unit, rebel group, or guerrilla group?

If you answered “Yes” to Item Number 8.a. or Item Number 8.b., include the name of the country, the name of the military unit or armed group, your rank or position, and your dates of involvement in your explanation in Part 14. Additional Information.

9.Have you EVER worked, volunteered, or otherwise served in a place where people were detained (forced to stay), for example, a prison, jail, prison camp (a camp where prisoners of war or political prisoners are kept), detention facility, or labor camp, or have you EVER directed or participated in any other activity that involved detaining people?

10.a. 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?

10.b. If you answered “Yes” to Item Number 10.a., when you were part of this group, or when you helped this group, did you ever use a weapon against another person?

10.c. If you answered “Yes” to Item Number 10.a., when you were part of this group, or when you helped this group, did you ever threaten another person that you would use a weapon against that person?

11.Have you EVER sold, provided, or transported weapons, or assisted any person in selling, providing, or transporting weapons, which you knew or believed would be used against another person?

12.Have you EVER received any weapons training, paramilitary training, or other military-type training?

13.Have you EVER recruited (asked), enlisted (signed up), conscripted (required to join), or used any person under 15 years of age to serve in or help an armed group, or attempted or worked with others to do so?

14.Have you EVER used any person under 15 years of age to take part in hostilities or attempted or worked with others to do so? This could include participating in combat or providing services related to combat (such as serving as a messenger or transporting supplies).

Yes Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes Yes

Yes

No No

No

No

No

No

No

No

No

No No

No

Part 9. Additional Information About You (continued)

A-

Received a suspended sentence, clemency, amnesty, or pardon for, or were placed on probation or paroled for.

15.a. Have you EVER committed, agreed to commit, asked someone else to commit, helped commit, or tried to commit a crime or offense for which you were NOT arrested?

15.b. Have you EVER been arrested, cited, detained or confined by any law enforcement officer, military official (in the U.S. or elsewhere), or immigration official for any reason, or been charged with a crime or offense?

Yes

Yes

No

No

What was the crime or offense? (If convicted, provide crime of conviction. If not convicted, provide crime or offense listed in arrest, citation, charging document, or crime committed.)

Date of the Crime

or Offense

(mm/dd/yyyy)

Date of your conviction or guilty plea (if applicable) (mm/dd/yyyy)

Place of Crime or

Offense (City or

Town, State, Country)

What was the result or disposition of the arrest, citation, or

charge? (no charges

filed, convicted, charges

dismissed, detention, jail, probation, etc.)

What was your

sentence

(if applicable)? (For example, 90 days in jail, 90 days on probation)

16.If you received a suspended sentence, were placed on probation, or were paroled, have you completed your suspended sentence, probation, or parole?

Yes

No

Have you EVER:

17.a. Engaged in prostitution, attempted to procure or import prostitutes or persons for the purpose of prostitution, or received any proceeds or money from prostitution?

17.b. Manufactured, cultivated, produced, distributed, dispensed, sold, or smuggled (trafficked) any controlled substances, illegal drugs, narcotics, or drug paraphernalia in violation of any law or regulation of a U.S. state, the United States, or a foreign country?

17.c. Been married to more than one person at the same time? 17.d. Married someone in order to obtain an immigration benefit?

17.e. Helped anyone to enter, or try to enter, the United States illegally? 17.f. Gambled illegally or received income from illegal gambling?

17.g. Failed to support your dependents (pay child support) or to pay alimony (court-ordered financial support after divorce or separation)?

17.h. Made any misrepresentation to obtain any public benefit in the United States?

18.Have you EVER given any U.S. Government officials any information or documentation that was false, fraudulent, or misleading?

19.Have you EVER lied to any U.S. Government officials to gain entry or admission into the United States or to gain immigration benefits while in the United States?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes Yes

Yes

No

No

No

No

No

No

No

No No

No

20.Have you EVER been placed in removal, rescission, or deportation proceedings?

21.Have you EVER been removed or deported from the United States?

Yes Yes

No No

22.a. Are you a male who lived in the United States at any time between your 18th and 26th birthdays? (Do not select “Yes” if you were a lawful nonimmigrant for all of that time period.)

22.b. If you answered “Yes,” to Item Number 22.a., did you register for the Selective Service? 22.c. If you answered “Yes,” to Item Number 22.b., provide information about your registration.

Yes

Yes

No

No

If you answered “No” to Item Number 25., go to Item Number 30.a.

26.a. Are you currently a member of the U.S. armed forces?

26.b. If you answered “Yes” to Item Number 26.a., are you scheduled to deploy outside the United States, including to a vessel, within the next 3 months? (Call the Military Help Line at 877-247-4645 if you transfer to a new duty station after you file your Form N-400, including if you are deployed outside the United States or to a vessel.)

26.c. If you answered “Yes,” to Item Number 26.a., are you currently stationed outside the United States?

26.d. If you answered “No” to Item Number 26.a., are you a former U.S. military service member who is currently residing outside of the U.S.?

Yes Yes

Yes Yes

No No

No No

Yes

Yes

No

No

30.a. Do you now have, or did you EVER have, a hereditary title or an order of nobility in any foreign country?

Yes

No (skip to Item Number 31.)

If you answer “'No” to any question except Item Number 33., see the Oath of Allegiance section of the Instructions for more information.

No

31.Do you support the Constitution and form of Government of the United States?

32.Do you understand the full Oath of Allegiance to the United States (see Part 16. Oath of Allegiance)?

33.Are you unable to take the Oath of Allegiance because of a physical or developmental disability or mental impairment? If you answer “Yes,” skip Item Numbers 34. - 37. and see the Legal Guardian, Surrogate, or Designated Representative section in the Instructions.

34.Are you willing to take the full Oath of Allegiance to the United States?

35.If the law requires it, are you willing to bear arms (carry weapons) on behalf of the United States?

36.If the law requires it, are you willing to perform noncombatant services (do something that does not include fighting in a war) in the U.S. armed forces?

37.If the law requires it, are you willing to perform work of national importance under civilian direction (do non-military work that the U.S. Government says is important to the country)?

Yes Yes

Yes

Yes

Yes

Yes

Yes

No No

No

No

No

No

No