Fillable Printable Sample Immigration Change of Address Form
Fillable Printable Sample Immigration Change of Address Form
Sample Immigration Change of Address Form
Form N-400 09/13/13 N
For
USCIS
Use
Only
Other (explain):
5.
Are applying on the basis of qualifying military service.
4.
3.
Have been a 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
of filing your Form N-400.
2.
Have been a Permanent Resident of the United States for at least 5 years.
1.
You are at least 18 years old and
Part 1. Information About Your Eligibility
(Check only one box or your
Form N-400 may be delayed)
Enter Your 9 Digit A-Number:
Date Stamp
Remarks
Your Current Legal Name (do not provide a nickname)
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
1.
Part 2. Information About You
(Person applying for naturalization)
Family Name (Last Name) Given Name (First Name)
Your Name Exactly As It Appears on Your Permanent Resident Card (if applicable)2.
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
Other Name(s) You Have Used Since Birth (include nicknames, aliases, and maiden name if applicable)3.
Are a 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. (Section 319(b) of the Immigration and Nationality Act)
Middle Name (if applicable)
Type or print all your answers 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 USCIS processing your Form N-400. NOTE: You must
complete Parts 1. - 14.
►
A-
Action BlockReceipt
Page 1 of 21
Application For Naturalization
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form N-400
OMB No. 1615-0052
Expires 09/30/2015
Form N-400 09/13/13 N
Part 2. Information About You
(continued)
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
If ''Yes," print the new name you would like to use in the space below.
NoYesWould you like to legally change your name?
Read the Form N-400 Instructions before you decide whether or not you would like to legally change your name.
Name Change (optional)4.
Date You Became a Permanent Resident
(mm/dd/yyyy)
7.6.U.S. Social Security Number
(if applicable)
5.
Country of Citizenship or Nationality
9.Country of Birth 8.
Blind or low vision.
Use a wheelchair or other device that assists with mobility.
Deaf or hard of hearing and need an interpreter who uses the following sign language (e.g., American Sign Language):
If "Yes," check the box(es) below that applies:
NoYes
Are you requesting an accommodation(s) to the naturalization process because of a disability and/or
an impairment? (See Form N-400 Instructions for accommodation examples)
10.
Require another type of accommodation. (explain):
NoYes
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?
11.
If "Yes," submit a completed Form N-648, Medical Certification for Disability Exceptions, when you file your Form N-400.
12. 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 Permanent Resident for
periods totaling at least 20 years at the time of filing your Form N-400?
NoYes
B. Are you 55 years of age or older and have you lived in the United States as a Permanent Resident for
periods totaling at least 15 years at the time of filing your Form N-400?
NoYes
C. Are you 65 years of age or older and have you lived in the United States as a Permanent Resident for
periods totaling at least 20 years at the time of filing your Form N-400? (If you meet this requirement,
you will also be given a simplified version of the civics test.)
NoYes
A-
Date of Birth
(mm/dd/yyyy)
► ►
Page 2 of 21
Form N-400 09/13/13 N
Part 3. Information to Contact You
E-mail Address (if any)
Work Phone Number (if any)Daytime Phone Number 1. Evening Phone Number
Mobile Phone Number (if any) 5.
Part 4. Information About Your Residence
City State ZIP Code + 4
Street Number and Name
Mailing Address (if different from the address above)A.
C/O ("In Care Of" Name, if applicable)
1.
NumberFlr.Ste.Apt.
A-
( )
-
( )
-
( )
-
2. 3.
4.
( )
-
Postal Code (foreign address only)Country (foreign address only)Province or Region (foreign address only)
Page 3 of 21
-
Province or Region (foreign address only)
City
Street Number and Name
ZIP Code + 4StateCounty
From (mm/dd/yyyy)
To (mm/dd/yyyy)
NumberFlr.Ste.Apt.
► ►
Postal Code (foreign address only)Country (foreign address only)
-
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(s) of paper.
Date of Residence
Form N-400 09/13/13 N
Part 4. Information About Your Residence
(continued)
A-
2.
Street Number and Name
Date of Residence
From (mm/dd/yyyy)
To (mm/dd/yyyy)
NumberFlr.Ste.Apt.
► ►
City County State ZIP Code + 4
-
ZIP Code + 4StateCountyCity
Street Number and Name
ZIP Code + 4StateCountyCity
Street Number and Name NumberFlr.Ste.Apt.
NumberFlr.Ste.Apt.
Date of Residence From (mm/dd/yyyy)
3.
► To (mm/dd/yyyy) ►
Date of Residence From (mm/dd/yyyy)
4.
► To (mm/dd/yyyy) ►
Postal Code (foreign address only)Country (foreign address only)Province or Region (foreign address only)
Postal Code (foreign address only)Country (foreign address only)Province or Region (foreign address only)
-
-
Postal Code (foreign address only)Country (foreign address only)Province or Region (foreign address only)
Page 4 of 21
Form N-400 09/13/13 N
American Indian
or Alaska Native
Part 5. Information About Your Parents
A-
Page 5 of 21
If your biological or legally adoptive mother or father is a U.S. citizen by birth, or naturalized before you reached your 18th
birthday, you may already be a U.S. citizen. Visit the USCIS Web site at www.uscis.gov for further information on this topic
before you consider filing Form N-400.
NoYes
1. Were your parents married before your 18th birthday?
2. Is your mother a U.S. citizen?
NoYes
If "Yes," complete the following information.
B. Mother's Country of Birth
Mother's Date of Birth (mm/dd/yyyy)
C.
A. Current Legal Name of U.S. Citizen Mother
Mother's Middle Name (if applicable)Mother's Given Name (First Name)Mother's Family Name (Last Name)
►
Is your father a U.S. citizen?
NoYes
A. Current Legal Name of U.S. Citizen Father
Father's Middle Name (if applicable)Father's Given Name (First Name)Father's Family Name (Last Name)
B. Father's Country of Birth C.
Father's Date of Birth (mm/dd/yyyy)
3.
NOTE: USCIS requires you to complete the categories below to conduct background checks. (See Form N-400 Instructions for more
information)
Part 6. Information for Criminal Records Check
Height
Feet Inches
Gender
Race (Select one or more)
Male Female
1.
4.
2.
Native Hawaiian or
Other Pacific Islander
If ''Yes," complete the information below.
►
Bald (No hair)SandyRedWhiteGrayBlondeBrownBlack
Hair color5.
Black or
African American
AsianWhite
Not Hispanic or Latino
Hispanic or Latino
Ethnicity (Select one)3.
Form N-400 09/13/13 N
Part 6. Information for Criminal Records Check
(continued)
A-
Page 6 of 21
List where you have worked or attended school full time or part time during the last 5 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 5 years. If you worked for yourself, write "self-employed." If you were
unemployed, write "unemployed." If you need more space, use an additional sheet(s) of paper to complete Part 7.
City State ZIP Code + 4
NumberFlr.Ste.Apt.Street Number and Name
-
Employer or School Name
1.
Your Occupation
Date From (mm/dd/yyyy) Date To (mm/dd/yyyy)
2.
Employer or School Name
City State ZIP Code + 4
Street Number and Name NumberFlr.Ste.Apt.
► ►
Your Occupation
Date From (mm/dd/yyyy) Date To (mm/dd/yyyy)
► ►
-
Postal Code (foreign address only)Country (foreign address only)Province or Region (foreign address only)
Postal Code (foreign address only)Country (foreign address only)Province or Region (foreign address only)
Part 7. Information About Your Employment and Schools You Attended
6.
Brown Blue Green Hazel Gray Black Pink Maroon Other
Eye color
Form N-400 09/13/13 N
A-
Page 7 of 21
Part 7. Information About Your Employment and Schools You Attended
(continued)
3.
Employer or School Name
Street Number and Name NumberFlr.Ste.Apt.
ZIP Code + 4StateCity
Your Occupation
Date From (mm/dd/yyyy) Date To (mm/dd/yyyy)
► ►
-
Postal Code (foreign address only)Country (foreign address only)Province or Region (foreign address only)
List below all the trips of 24 hours or longer that you have taken outside the United States during the last 5 years. 3.
NoYes
Yes No
NoYes
Yes No
NoYes
Date You Left the
United States
(mm/dd/yyyy)
Date You Returned
to the United States
(mm/dd/yyyy)
Did Trip Last 6
Months or More?
Yes No
Countries to
Which You Traveled
Total Days
Outside the
United States
How many trips of 24 hours or longer have you taken outside the United States during the last 5 years?
trips
2.
How many total days (24 hours or longer) did you spend outside the United States during the last 5 years?
days
1.
Part 8. Time Outside the United States
Begin with your most recent trip and work backwards. If you need more space, use an additional sheet(s) of paper.
Form N-400 09/13/13 N
Part 9. Information About Your Marital History
A-
Page 8 of 21
What is your current marital status?
How many times have you been married (including annulled marriages and marriage(s) to the same person)?
If you are single and have never been married, indicate "0" and go to Part 10.
If you are married now, provide the following information about your current spouse.
Legal Name of Current Spouse
B.
A.
1.
3.
4.
DivorcedSingle, never married WidowedMarried Marriage annulled
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
Separated
2. If you are married, is your spouse a current member of the U.S. Armed Forces?
Previous Legal Name of Current Spouse
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
Other Names Used by Current Spouse (include nicknames, aliases, and maiden name, if applicable)
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
C.
NoYes
Country (foreign address only)
Street Number and Name
Province or Region (foreign address only) Postal Code (foreign address only)
ZIP Code + 4StateCountyCity
F. Current Spouse's Present Home Address
Current Spouse's Present EmployerG.
NumberFlr.Ste.Apt.
-
D. Current Spouse's Date of Birth Date You Entered into Marriage with Current SpouseE.
► ►(mm/dd/yyyy)(mm/dd/yyyy)
5. Is your current spouse a U.S. citizen?
NoYes
If ''Yes," answer Item Number 6.
If ''No," go to Item Number 7.
Form N-400 09/13/13 N
Part 9. Information About Your Marital History
(continued)
A-
Page 9 of 21
Date your current spouse became a U.S. citizen
B.
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 applicable)
Current Spouse's Immigration StatusC.
Other (explain):Permanent Resident
When did your current spouse become a U.S. citizen?
A.
If your current spouse is a U.S. citizen, complete the following information.6.
At birth Other - Complete the following information.
- Go to Item Number 8.
►(mm/dd/yyyy)
►
A-
If your current spouse has had more than one previous marriage, use an additional sheet(s) of paper to provide the
information requested in Items A. - H. below for each marriage.
A.
B. Prior Spouse's Immigration Status
U.S. Citizen Permanent Resident Other (explain):
Middle Name (if applicable)
Given Name (First Name)Prior Spouse's Family Name (Last Name)
C. Prior Spouse's Date of Birth Prior Spouse's Country of Birth D.
E. Prior Spouse's Country of Citizenship or Nationality
Date of Marriage with Prior SpouseF. Date Marriage Ended with Prior SpouseG.
H. How Marriage Ended with Prior Spouse
Annulled Divorced Spouse Deceased Other (explain):
►(mm/dd/yyyy)
►(mm/dd/yyyy) ►(mm/dd/yyyy)
How many times has your current spouse been married (including annulled marriages and marriage(s)
to the same person)? If your current spouse has been married before, provide the following information about
your current spouse's prior spouse.
8.
Form N-400 09/13/13 N
Part 9. Information About Your Marital History
(continued)
A-
Page 10 of 21
If you were married before, provide the following information about your prior spouse. If you have more than one previous
marriage, use an additional sheet(s) of paper to provide the information requested in Items A. - H. below for each
marriage.
9.
Other (explain):Spouse DeceasedDivorcedAnnulled
A.
B. Your Prior Spouse's Immigration Status When Your Marriage Ended
U.S. Citizen Permanent Resident Other (explain):
Middle Name (if applicable)
Given Name (First Name)Your Prior Spouse's Family Name (Last Name)
C. Your Prior Spouse's Date of Birth
F. G.Date of Marriage with Your Prior Spouse
H.
Date Marriage Ended with Your Prior Spouse
How Marriage Ended with Your Prior Spouse
►(mm/dd/yyyy)
►(mm/dd/yyyy) ►(mm/dd/yyyy)
Your Prior Spouse's Country of Birth D.
Your Prior Spouse's Country of Citizenship or NationalityE.
Provide the following information about all your children (sons and daughters) listed in Item Number 1., regardless of age.
Use an additional sheet(s) of paper to list any additional children.
2.
Indicate your total number of children. (All children should be indicated, including: A. Children who are alive,
missing, deceased; B. Children born in the United States or in other countries; C. Children under 18 years of age
or older; D. Children who are currently married or unmarried; E. Children living with you or elsewhere;
F. Current stepchildren; G. Legally adopted children; and H. Children born when you were not married.)
1.
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
Child's Current Legal NameA.1.
Child's A-Number (if applicable)A.2.
Child's Country of BirthA.4.
►
A-
►(mm/dd/yyyy)
Child's Date of BirthA.3.
Part 10. Information About Your Children
Form N-400 09/13/13 N
Part 10. Information About Your Children
(continued)
A-
Page 11 of 21
Child's Current Legal NameB.1.
B.2.
Middle Name (if applicable)Given Name (First Name)Family Name (Last Name)
Child's A-Number (if applicable)
►
A-
►(mm/dd/yyyy)
Child's Date of BirthB.3.
Child's Country of BirthB.4.
Child's Current Address A.5.
Country (foreign address only)
Street Number and Name
Province or Region (foreign address only) Postal Code (foreign address only)
ZIP Code + 4StateCountyCity
What is your child's relationship to you? (e.g., biological child, stepchild,
legally adopted child)
A.6.
NumberFlr.Ste.Apt.
-
B.5.
B.6.
Child's Current Address
Country (foreign address only)
Street Number and Name
Province or Region (foreign address only) Postal Code (foreign address only)
ZIP Code + 4StateCountyCity
NumberFlr.Ste.Apt.
What is your child's relationship to you? (e.g., biological child, stepchild,
legally adopted child)
-
