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Fillable Printable Form N-600K

Fillable Printable Form N-600K

Form N-600K

Form N-600K

Form N-600K 02/13/17 NPage 1 of 13
Application for Citizenship and Issuance
of Certificate Under Section 322
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form N-600K
OMB No. 1615-0087
Expires 12/31/2018
To be completed
by an Attorney
or Accredited
Representative (if any).
Select this box if
Form G-28 is
attached.
Attorney State Bar Number
(if applicable)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
START HERE - Type or print in black ink.
The ADOPTED child of a qualifying USC parent filing this application.
The BIOLOGICAL child of a qualifying U.S. citizen (USC) parent filing this application.
The application is being filed for a child. The child is under 18 years of age and
(Select only one box):
Part 1. Information About the Child's Eligibility
Child's A-Number:
A-
1.
The grandchild of a qualifying USC grandparent or the child ward of a USC legal guardian filing this application within
five years of the death of the USC parent.
For
USCIS
Use
Only
Date Stamp
Remarks
Action BlockReceipt
Part 2. Information About the Child (for whom this application is being filed)
Current Legal Name (do not provide a nickname)
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 the Permanent Resident Card (if applicable)2.
Middle Name
Middle NameGiven Name (First Name)Family Name (Last Name)
Other Names Used (if applicable)
Provide all other names you have ever used, including nicknames, maiden name, and aliases.
3.
U.S. Social Security Number(if applicable)4.
5.USCIS Online Account Number (if any)
6.
Date of Birth(mm/dd/yyyy)
Country of Birth
7.
Form N-600K 02/13/17 NPage 2 of 13
11.
Apt.Ste.Flr.Street Number and NameNumber
City or TownStateZIP Code
-
Province
Postal CodeCountry
12.
Street Number and NameApt.Ste.Flr.Number
City or TownStateZIP Code
-
Province
Postal CodeCountry
Physical Address (Do not provide a PO Box in this space unless it is the ONLY address.)
13.
Marital Status
Single, Never Married
MarriedDivorcedWidowed
Separated
Marriage Annulled
Other (Explain):
14.Information About the Admission Into the United States and Current Immigration Status
NOTE: Do NOT complete this section. The USCIS officer will complete it during the interview.
Arrived in the following manner:
A.
Port-of-Entry
City or TownStateDate of Entry (mm/dd/yyyy)
B.
Current Immigration Status
Part 2. Information About the Child (for whom this application is being filed)
(continued)
15.Was there any prior application for citizenship or for a U.S. passport?
YesNo
Prior Country of Citizenship or Nationality
8.
Gender
MaleFemale
9.
A-
Mailing Address
In Care Of Name (if any)
Exact Name Used at Time of Entry
Family Name (Last Name)
Given Name (First Name)
Middle Name
Height
FeetInches
10.
Form N-600K 02/13/17 NPage 3 of 13
Part 2. Information About the Child (for whom this application is being filed)
(continued)
16.Was the child adopted?
YesNo
A.
Date of Adoption
(mm/dd/yyyy)
B.
Date Legal Custody Began
(mm/dd/yyyy)
C.
Date Physical Custody Began
(mm/dd/yyyy)
17.Were the child's parents married to each other when the child was born (or adopted)?
YesNo
Part 3. Information About the Child's U.S. Citizen Biological or Adoptive Parent
NOTE: Provide information about the U.S. citizen father or mother applying on behalf of the eligible child. Provide information
about the child's U.S. citizen parent in the sections noted if the U.S. citizen grandparent or legal guardian is filing this form.
1.Current Legal Name of U.S. Citizen Parent
Family Name (Last Name)
Given Name (First Name)Middle Name
2.
Date of Birth(mm/dd/yyyy)
3.
Country of Birth
4.U.S. Social Security Number(if applicable)
5.Physical Address
Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.)
Apt.Ste.Flr.Number
City or TownStateZIP Code
-
Province
Postal CodeCountry
6.Daytime Telephone Number7.Work Telephone Number (if any)
8.Evening Telephone Number9.Mobile Telephone Number (if any)
10.Email Address (if any)
A-
Form N-600K 02/13/17 NPage 4 of 13
Part 3. Information About the Child's U.S. Citizen Biological or Adoptive
Parent (continued)
Naturalization
Place of Naturalization
12.Has the U.S. citizen father or mother ever lost U.S. citizenship or taken any action that would cause
loss of U.S. citizenship?
YesNo
If the answer is “Yes” to Item Number 12., provide a full explanation in the space provided in Part 11. Additional Information.
13.Marital History
A.
How many times has the U.S. citizen father or mother been married (including annulled
marriages and marriages to the same person)?
B.
What is the U.S. citizen father or mother's current marital status?
Single, Never Married
MarriedDivorcedWidowed
Separated
Marriage Annulled
Other (Explain):
C.
Information About the U.S. Citizen Father's or Mother's Current Spouse
Family Name (Last Name)
Given Name (First Name)Middle Name
Date of Birth(mm/dd/yyyy)
Country of Birth
Country of Citizenship or Nationality
Spouse's Physical Address
Street Number and Name (Do not provide a PO Box in this space unless it is your spouse's
ONLY address.)Apt.Ste.Flr.Number
City or TownStateZIP Code
-
Province
Postal Code Country
A-
City or TownState
Name of Court or USCIS Office Location
A-
A-Number (if known)Certificate of Naturalization Number
Date of Naturalization (mm/dd/yyyy)
11.The parent is a U.S. citizen by:
Birth in the United StatesAcquisition after birth through naturalization of alien parents
Birth abroad to U.S. citizen parents
Certificate of Citizenship Number
Alien Registration Number (A-Number) (if known)
A-
Form N-600K 02/13/17 NPage 5 of 13
Part 3. Information About the Child's U.S. Citizen Biological or Adoptive
Parent (continued)
14.Member of U.S. Armed Forces
A.Is the sponsoring U.S. citizen parent a member of the U.S. Armed Forces?
YesNo
B.If the answer is “Yes,” then are there official orders authorizing the child to accompany and reside
with the sponsoring U.S. citizen parent who is a member of the U.S. Armed Forces?
YesNo
NOTE:If the U.S. citizen biological or adoptive parent is filing this application AND has the required physical
presence in the United States, skip Part 4. and go directly to Part 5.
Part 4. Information About the Child's Qualifying U.S. Citizen Grandparent
NOTE: Complete this part only if the U.S. citizen parent (or adoptive parent), grandparent, or legal guardian is applying for
citizenship for the child, and the U.S. citizen parent has not been physically present in the United States for five years; two years of
which were after 14 years of age.)
1.Current Legal Name of U.S. Citizen Grandparent
Family Name (Last Name)
Given Name (First Name)Middle Name
2.
Date of Birth(mm/dd/yyyy)
3.
Country of Birth
4.U.S. Social Security Number(if applicable)
5.
Physical Address
Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.)
Apt.Ste.Flr.Number
City or TownStateZIP Code
-
Province
Postal CodeCountry
6.
Daytime Telephone Number
7.
Work Telephone Number (if any)
A-
NoYes
Is the U.S. citizen father's or mother's current spouse also the child's biological (or adoptive) parent?D.
Spouse's Immigration Status
U.S. CitizenLawful Permanent ResidentOther (Explain):
Date of Marriage (mm/dd/yyyy)
Place of Marriage
CountryStateCity or Town
Form N-600K 02/13/17 NPage 6 of 13
Part 4. Information About the Child's Qualifying U.S. Citizen Grandparent
(continued)
12.Has the grandparent ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?
If the answer is “Yes” to Item Number 12., provide a full explanation in the space provided in Part 11.
Additional Information.
Part 5. Physical Presence in the United States From Birth Until Filing of Form N-600K
NOTE: Provide the dates that the U.S. citizen parent or grandparent was present in the United States. If the U.S. citizen parent has
not been physically present in the United States for five years, two years of which were after 14 years of age, then the child must use
the physical presence of the U.S. citizen grandparent.
Indicate whether this information relates to the U.S. citizen parent or to the qualifying grandparent.
U.S. Citizen ParentU.S. Citizen Grandparent
NOTE:If the U.S. citizen biological/adoptive parent is filing this application, skip Part 6. and go directly to Part 7.
No
Yes
A-
1.
2.
Physical Presence in the United States
A.From(mm/dd/yyyy)
Until(mm/dd/yyyy)B.From(mm/dd/yyyy)Until(mm/dd/yyyy)
C.From(mm/dd/yyyy)Until(mm/dd/yyyy)D.From(mm/dd/yyyy)Until(mm/dd/yyyy)
E.From(mm/dd/yyyy)Until(mm/dd/yyyy)F.From(mm/dd/yyyy)Until(mm/dd/yyyy)
G.From(mm/dd/yyyy)Until(mm/dd/yyyy)H.From(mm/dd/yyyy)Until(mm/dd/yyyy)
Birth abroad to U.S. citizen parents
Certificate of Citizenship NumberA-Number (if known)
A-
Naturalization
Place of Naturalization
City or TownState
Name of Court or USCIS Office Location
A-
A-Number (if known)Certificate of Naturalization Number
Date of Naturalization (mm/dd/yyyy)
11.The grandparent is a U.S. citizen by:
Birth in the United States
Acquisition after birth through naturalization of alien parents
8.
Evening Telephone Number
9.
Mobile Telephone Number (if any)
10.Email Address (if any)
Form N-600K 02/13/17 NPage 7 of 13
8.Evening Telephone Number9.Mobile Telephone Number (if any)
10.Email Address (if any)
11.The legal guardian is a U.S. citizen by:
Birth in the United StatesAcquisition after birth through naturalization of alien parents
Birth abroad to U.S. citizen parents
Certificate of Citizenship Number
A-Number (if known)
A-
5.
Physical Address
Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.)
Apt.Ste.Flr.Number
City or TownStateZIP Code
-
Province
Postal CodeCountry
6.Daytime Telephone NumberWork Telephone Number (if any)
7.
Part 6. Information About the Legal Guardian
2.
Date of Birth(mm/dd/yyyy)
3.
Country of Birth
4.U.S. Social Security Number(if applicable)
A-
Naturalization
Place of Naturalization
City or TownState
Name of Court or USCIS Office Location
A-
A-Number (if known)Certificate of Naturalization Number
Date of Naturalization (mm/dd/yyyy)
NOTE: Complete this part only if your legal guardian is filing this application in lieu of a deceased U.S. citizen parent.
1.Current Legal Name of the Legal Guardian
Family Name (Last Name)Given Name (First Name)Middle Name
Form N-600K 02/13/17 NPage 8 of 13
B.
2.Applicant's Statement Regarding the Preparer
Part 8. Applicant's Statement, Contact Information, Certification, and Signature
NOTE: Read the Penalties section of the Form N-600K 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.
Part 6. Information About the Legal Guardian (continued)
1.
2.
City or TownState
USCIS will attempt to accommodate the requested preferences.
NOTE: Interview date should be at least 90 days after filing Form N-600K and before the child's 18th birthday.
USCIS Office Location
Preferred Date(mm/dd/yyyy)
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.
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.
At my request, the preparer named in Part 10.,
application for me based only upon information I provided or authorized.
, prepared this
A-
Part 7. Preferred Location and Date for Interview
12.Date of Legal Guardianship
(mm/dd/yyyy)
13.
Name of Authority that Granted
Legal Guardianship
14.
Address of Authority that Granted Legal Guardianship
Street Number and Name (Do not provide a PO Box in this space unless it is your ONLY address.)
Apt.Ste.Flr.Number
City or TownStateZIP Code
-
Province
Postal CodeCountry
Form N-600K 02/13/17 NPage 9 of 13
Part 9. 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)Interpreter's Given Name (First Name)
2.Interpreter's Business or Organization Name (if any)
Applicant'sSignature
6.Applicant's Signature (sign in ink)Date of Signature (mm/dd/yyyy)
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.
Part 8. Applicant's Statement, Contact Information, Certification, and
Signature (continued)
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.
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 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 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:
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.
Applicant's Contact Information
3.
Applicant's Daytime Telephone Number
4.Applicant's Mobile Telephone Number (if any)
5.Applicant's Email Address (if any)
Form N-600K 02/13/17 NPage 10 of 13
Interpreter's Certification
Interpreter's Signature
7.Interpreter's Signature (sign in ink)Date of Signature (mm/dd/yyyy)
Part 9. Interpreter's Contact Information, Certification, and Signature
(continued)
Item B. in ItemNumber 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.
, which is the same language specified in Part 8.,
I am fluent in English and
I certify, under penalty of perjury, that:
A-
Interpreter's Contact Information
4.Interpreter's Daytime Telephone Number5.Interpreter's Mobile Telephone Number (if any)
6.Interpreter's Email Address (if any)
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.Preparer's Family Name (Last Name)Preparer's Given Name (First Name)
2.Preparer's Business or Organization Name (if any)
City or TownStateZIP Code
-
ProvincePostal CodeCountry
Interpreter's Mailing Address
3.Street Number and NameApt.Ste.Flr.Number
Form N-600K 02/13/17 NPage 11 of 13
Preparer's Statement
7.A.
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.
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.
8.Preparer's Signature (sign in ink)
Date of Signature (mm/dd/yyyy)
Part 10. Contact Information, Declaration, and Signature of the Person
Preparing this Application, if Other Than the Applicant (continued)
does not extend beyond the preparation of this application.extends
I am an attorney or accredited representative and my representation of the applicant in this case
Preparer's Signature
A-
Preparer's Contact Information
4.
Preparer's Daytime Telephone Number
5.Preparer's Mobile Telephone Number (if any)
6.Preparer's Email Address (if any)
Preparer's Mailing Address
3.Street Number and NameApt.Ste.Flr.Number
City or TownStateZIP Code
-
ProvincePostal CodeCountry
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