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Request For Certification Of Military Or Naval Service N-426 - Official Federal Forms
| Request For Certification Of Military Or Naval Service Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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OMB No. 1615-0053 ; Expires 02/28/2013 Department of Homeland Security U.S. Citizenship and Immigration Services Form N-426, Request for Certification of Military or Naval Service For USCIS Use Only Date Returned: To: Initials: Comments: Persons who are serving or have served under specified conditions in the Armed Forces of the United States are granted certain exemptions from the general requirements for naturalization. To establish eligibility, the law requires the department with custody of the service record to certify whether the service member served honorably, and whether each separation from the service was under honorable conditions. Certification of the service member's military service listed on this form is required. Submit this form with Form N-400, Application for Naturalization. For further assistance, contact the Military Help Line, 1-877-CIS-4MIL (1-877-247-4645) or visit www.uscis.gov/ military. Alien Registration Number Military Service Number Date of Request A Name Used During Military Service (Last, First, Middle) U.S. Social Security Number Date of Birth Place of Birth (Country and City) Present Address: Phone Number(s): E-Mail Address(es): Military Service List all periods of service. (attach an additional sheet(s) if you need to provide more information.) TO BE COMPLETED BY APPLICANT OR CERTIFYING OFFICIAL Branch of Service Date Service Began Date Service Ended Type of Service (includes all active, reserve, and National Guard Service) Active Duty Selected Reserve of the Ready Reserve* Active Duty Yes Selected Reserve of the Ready Reserve* Active Duty Selected Reserve of the Ready Reserve* *Selected Reserve of the Ready Reserve members: (1) participate in at least 48 scheduled drills or training periods during each year and serve on active duty for training at least 14 days each year; or (2) participate in training at encampments, maneuvers, outdoor target practice, or other exercises at least 15 days each year. (10 U.S.C. 10143) Yes No (give details in Remarks) No (give details in Remarks) TO BE COMPLETED BY CERTIFYING OFFICIAL Applicant served honorably or is currently serving honorably? Yes No (give details in Remarks) Where did the applicant enlist (Country, State, and City where the applicant entered service)? Has the applicant reenlisted? Signature of Applicant Yes No Where did the applicant reenlist? Separation Information Is the applicant separated? If separated, select discharge type: Was the applicant discharged on account of alienage? Yes Honorable Yes No Other (give details in Remarks section) No (if "Yes," give details in Remarks section) Remarks Use for continuation of any of the above items. You should also list in the space below any derogatory information in your records relating to the service member's character, loyalty to the United States, disciplinary actions, convictions, or other matters concerning his or her fitness for citizenship. (Use a blank sheet if more space is needed.) Certification TO BE COMPLETED BY CERTIFYING OFFICIAL I am authorized to certify that the information given here concerning the service of the person named on this form is correct according to the records of the Official Signature Name of Department [SEAL, if available] (No State-issued notary Public seals accepted.) Name and Title Date _______________, ______________ Phone Number and E-Mail Address Form N-426 (02/09/12) Y American LegalNet, Inc. www.FormsWorkFlow.com
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