Part 1. Your Name (Person applying for naturalization)
Write your USCIS A-Number here:
N-400 Application
for Naturalization
Print clearly or type your answers using CAPITAL letters. Failure to print clearly may delay your application. Use black ink.
A
A. Your current legal name.
For USCIS Use Only
Bar Code
Date Stamp
Full Middle Name (If applicable)
Given Name (First Name)
B. Your name exactly as it appears on your Permanent Resident Card.
Given Name (First Name)
Full Middle Name (If applicable)
C. If you have ever used other names, provide them below.
Middle Name
Given Name (First Name)
D. Name change (optional)
Yes
1. Would you like to legally change your name?
No
2. If ''Yes," print the new name you would like to use. Do not use initials or
abbreviations when writing your new name.
Family Name (Last Name)
Given Name (First Name)
Part 2. Information About Your Eligibility (Check only one)
I am at least 18 years old AND
I have been a lawful permanent resident of the United States for at least five years.
I have been a lawful permanent resident of the United States for at least three years, and I
have been married to and living with the same U.S. citizen for the last three years, and my
spouse has been a U.S. citizen for the last three years.
B.
C.
I am applying on the basis of qualifying military service.
D.
Other (Explain)
Department of Homeland Security
U.S Citizenship and Immigration Services
Family Name (Last Name)
Family Name (Last Name)
Family Name (Last Name)
Read the Instructions before you decide whether to change your name.
A.
Remarks
Action Block
Full Middle Name
OMB No. 1615-0052; Expires 12/31/09
Form N-400 (Rev. 01/22/09) Y
F. Are either of your parents U.S. citizens? (If yes, see instructions)
Part 3. Information About You
A
A. U.S. Social Security Number B. Date of Birth (mm/dd/yyyy)
D. Country of Birth
E. Country of Nationality
Yes
No
Widowed
Single, Never Married
Married
G. What is your current marital status?
Marriage Annulled or Other (Explain)
Yes
No
Are you requestin