Form N-600 02/13/17 NPage 1 of 15 ForUSCISUseOnly I am an ADOPTED child of a U.S. citizen parent. I am a BIOLOGICAL child of a U.S. citizen parent. This application is being filed based on the fact that:(Select only one box) Part 1. Information About Your Eligibility Enter Your 9 Digit A-Number:Date Stamp RemarksCurrent Legal Name(donotprovide a nickname)Family Name (Last Name)Given Name (First Name)Middle Name 1. Part 2. Information About You Family Name (Last Name)Given Name (First Name)Your Name Exactly As It Appears on Your Permanent Resident Card(if different from above)2. Middle Name START HERE - Type or print in black ink. A- Action BlockReceiptApplication for Certificate of Citizenship Department of Homeland Security U.S. Citizenship and Immigration Services USCISForm N-600 OMB No. 1615-0057 Expires 12/31/2018 1. Other(Explain fully): Middle NameGiven Name (First Name)Family Name (Last Name)Other Names You Have Used Since BirthProvide all other names you have ever used, include nicknames, maiden name, and aliases.3.6.Date of Birth(mm/dd/yyyy) U.S. Social Security Number(if any)4.Country of Birth7. 5.USCIS Online Account Number (if any) Select this box if Form G-28 is attached. To be completedby an Attorneyor Accredited Representative(if any). Attorney State Bar Number (if applicable)Attorney or Accredited Representative USCIS Online Account Number (if any) NOTE: Provide information about yourself if you are a person applying for the Certificate of Citizenship.Provide information about your child if you are a U.S. citizen parent applying for a Certificate of Citizenship for your minor child.NOTE:If you need extra space to complete this section, use the space provided in Part 11. Additional Information. Gender Male Female9.Country of Prior Citizenship or Nationality8. American LegalNet, Inc. www.FormsWorkFlow.com Form N-600 02/13/17 NPage 2 of 15 Part 2. Information About You (continued)A- 11.Physical AddressCity or Town State ZIP Code + 4 Number Flr. Ste. Apt. StreetNumberandName(DonotprovideaPOBoxinthisspaceunlessitisyourONLYaddress.)- PostalCode(foreignaddressonly) Province (foreign address only) Country (foreign address only)10.Mailing AddressIn Care Of Name (if any) Current Marital Status12. Divorced Single, Never Married Widowed Married Separated Other (Explain): 14.Information About Your Admission into the United States and Current Immigration Status Marriage Annulled I arrived in the following manner Port-of-EntryA. City or Town State Date of Entry (mm/dd/yyyy)Exact Name Used at Time of Entry Middle Name Given Name (First Name) Family Name (Last Name)City or Town State ZIP Code + 4 Number Flr. Ste. Apt. Street Number and Name- Postal Code (foreign address only) Province (foreign address only) Country (foreign address only)U.S. Armed Forces13. No YesAre you a member or veteran of any branch of the U.S. Armed Forces?I used the following travel document to be admitted to the United StatesB. Travel Document Passport Passport Number Travel Document Number Country of Issuance for Passport or Travel DocumentDate Passport or Travel Document Issued (mm/dd/yyyy) American LegalNet, Inc. www.FormsWorkFlow.com Form N-600 02/13/17 NPage 3 of 15 A- Part 2. Information About You (continued)I obtained LPR status through adjustment of status in the United States or admission as a LPR (if applicable)D. Date I became a LPR (mm/dd/yyyy) U.S. Citizenship and Immigration Services (USCIS) Office That Granted My LPR Status or Location Where I Was Admitted No YesHave you previously applied for a Certificate of Citizenship or U.S. Passport?15.If you answered "Yes" to Item Number 15., provide an explanation below. If you need extra space to complete this section, use the space provided in Part 11. Additional Information. No Yes16.Have you ever abandoned or lost your LPR status?If you answered "Yes" to Item Number 16., provide an explanation below. If you need extra space to complete this section, use the space provided in Part 11. Additional Information. No YesWere you adopted?17.If you answered "Yes" to ItemNumber17., complete Items A. - D. Place of Final AdoptionA. No YesDid you have to be re-adopted in the United States?18.If you answered "Yes" to ItemNumber18., complete Items A. - D. Date of Final Adoption(mm/dd/yyyy)B. I amC. A Lawful Permanent Resident (LPR) A Nonimmigrant Other (Explain): A Refugee/Asylee NOTE:If you select 223Other224 and you need extra space to complete this section, use the space provided in Part 11. Additional Information. StateCity or Town Country Country State City or TownA.Place of Final Adoption Date Legal Custody Began (mm/dd/yyyy)C. Date Physical Custody Began (mm/dd/yyyy)D. Date Legal Custody Began (mm/dd/yyyy)C. Date Physical Custody Began (mm/dd/yyyy)D.Date of Adoption(mm/dd/yyyy) B. No YesWere your parents married to each other when you were born (or adopted)?19. No YesDid your parents marry after you were born?20. No YesDo you regularly reside in the United States in the legal and physical custody of your U.S. citizen parents?21. American LegalNet, Inc. www.FormsWorkFlow.com Form N-600 02/13/17 NPage 4 of 15 A- Part 2. Information About You (continued) Date You Left the United States (mm/dd/yyyy)A. Date You Returned to the United States(mm/dd/yyyy)B. Date You Left the United States (mm/dd/yyyy)D. Date You Returned to the United States(mm/dd/yyyy)E. Part 3. Biographic InformationAmerican Indian or Alaska NativeHeightFeetInches Race(Selectallapplicable boxes) 2.3. Native Hawaiian or Other Pacific Islander Black orAfrican AmericanAsianWhite Not Hispanic or Latino Hispanic or Latino Ethnicity (Select only one box)1.4.WeightPounds 5. Brown Blue Green Hazel Gray Black Pink Maroon Unknown/OtherEye color(Selectonlyone box)Bald(No hair) Sandy Red White Gray Blond Brown Black Hair color (Select onlyone box)6. Unknown/OtherComplete the following information only if you are claiming U.S. citizenship at the time of birth if you were born beforeOctober 10, 1952.If you need extra space to complete this section, use the space provided in Part 11. Additional Information. No YesHave you been absent from the United States since you first arrived?22. StateCity or Town F.Place of Entry Upon Return to the United States State City or TownC.Place of Entry Upon Return to the United States Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father)NOTE: Complete this section if you are claiming citizenship through a U.S. biological father (of adoptive father).Provideinformation about yourself if you are a U.S. citizen father applying for a Certificate of Citizenship on behalf of your minor biological or adopted child.Current Legal Name of U.S. Citizen FatherFamily Name (Last Name)Given Name (First Name)Middle Name1. American LegalNet, Inc. www.FormsWorkFlow.com Form N-600 02/13/17 NPage 5 of 15 A- Part 4. Information About Your U.S. Citizen Biological Father (or Adoptive Father) (continued) My father is a U.S. citizen by6. A- Alien Registration Number (A-Number) (if any) Certificate of Citizenship Number A- A-Number (if any) Certificate of Naturalization Number No YesHas your father ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?7.If you answered 223Yes224 to Item Number 7.,provide an explanation in Part 11. Additional Information.What is your U.S. citizen father's current marital status? Divorced Single, Never Married Widowed Married Marriage Annulled SeparatedMarital History8.A.How many times has your U.S. citizen father been married (including annulled marriages and marriages to the same person)? B.If you selected "Other," provide an explanation. If you need extra space to complete this section, use the space provided in Part 11. Additional Information. Other (Explain): Birth in the United StatesAcquisition after birth through naturalization of alien parentsBirth abroad to U.S. citizen parentsNaturalization5.Physical AddressCity or Town State ZIP Code + 4 Number Flr. Ste. Apt. StreetNumberandName(Typeorprint"Deceased"andthedateofdeathifyourfatherhaspassedaway.)- PostalCode(foreignaddressonly) Province (foreign address only) Country (foreign address only) State City or To