Department of Homeland Security U.S. Citizenship and Immigration Services N-644, Application for Posthumous Citizenship For USCIS Only Fee Stamp Part I. Information About the Applicant and Decedent (To be completed by the applicant only) A. Information About the Applicant 1. Name (Last/First/Middle) 8. Your Relationship to Decedent at Time of His/Her Death (Check one) Next-of-Kin 2. Address (Street Name and Number) A. B. (Town/City, State/Country, Zip/Postal Code) C. D. 3. If Abroad, City/Country of Nearest U.S. Embassy or Consulate E. F. 4. Date of Birth 5. A-Number, if applicable G. 6. Total Number of Authorization Affidavits Attached (See instructions) 9. E-mail Address 7. Telephone Number (Include Area/Country Code) Executor or Administrator of Decedent's Estate Guardian, Conservator, or Committee of Decedent's Next-of-Kin VA Recognized Service Organization (Name below) (Name of Service Organization) Spouse Parent Son/Daughter Brother/Sister Representative ( ) B. Information About the Decedent 1. Name Used During Active Service (Last/First/Middle) 7. Immigration Status at Time of Death (Permanent Resident, Student, Visitor, etc.) 2. Other Names Used 8. A-Number or Other USCIS File Number 3. Date of Birth (mm/dd/yyyy) 4. Place of Birth (City/State/Country) 9. U.S. Social Security Number (If any) 5. Date of Death (mm/dd/yyyy) 6. Place of Death (City/State/Country) Form N-644 08/05/15 N Page 1 American LegalNet, Inc. www.FormsWorkFlow.com B. Information About the Decedent (Continued) 10. Father's Full Name Living Deceased 11. Mother's Maiden Name Living Deceased C. 12. Marital Status at Time of Death a. Married b. Divorced c. Widowed d. Single D. Living Deceased Date of Birth (mm/dd/yyyy) B. Living Deceased Date of Birth (mm/dd/yyyy) Name (Last/First/Middle) Living Deceased Date of Birth (mm/dd/yyyy) Name (Last/First/Middle) 13. Military Service Serial Number (If different from Social Security Number) Name (Last/First/Middle) 14. Date Entered Active Duty Service (mm/dd/yyyy) E. 15. Place Entered Active Duty Service (City/State/Country) Living Deceased Name (Last/First/Middle) Date of Birth (mm/dd/yyyy) 16. Date Released From Active Duty Service (mm/dd/yyyy) 24. Total Number of Brothers and Sisters (If none, write "None") 17. Branch of Service 18. Type of Discharge 25. Complete the Following for Each Brother and Sister A. Living Deceased Date of Birth (mm/dd/yyyy) 19. Military Rank at Time of Discharge 20. Retired From Military? Yes No Name (Last/First/Middle) B. 21. VA Claim Number (If any) Living Deceased Date of Birth (mm/dd/yyyy) Name (Last/First/Middle) 22. Total Number of Children (If none, write "None") C. 23. Complete the Following for Each Child A. Living Deceased Date of Birth (mm/dd/yyyy) Living Deceased Date of Birth (mm/dd/yyyy) Name (Last/First/Middle) Name (Last/First/Middle) D. Living Deceased Date of Birth (mm/dd/yyyy) Name (Last/First/Middle) Form N-644 08/05/15 N Page 2 American LegalNet, Inc. www.FormsWorkFlow.com B. Information About the Decedent (Continued) E. Living Deceased Date of Birth (mm/dd/yyyy) Certificate of Applicant I certify, under penalty of perjury under the laws of the United States of America, that the information in Part I is true and correct. Signature Date (mm/dd/yyyy) Name (Last/First/Middle) F. Living Deceased Date of Birth (mm/dd/yyyy) Name (Last/First/Middle) Name (Print or Type) G. Living Deceased Date of Birth (mm/dd/yyyy) Address (Street Number and Name, City/Town, State/Province, Country, Zip-Postal Code Name (Last/First/Middle) Part II. To Be Completed by the Department of Defense Official for Appropriate Branch of Military Service 6. Individual Entered Service Under the Lodge Act? Yes 7. No Unable to Determine 1. 2. 3. 4. No Active Duty Records Found for This Individual No Casualty Records Found for This Individual Name of Decedent Correctly Shown Name of Decedent Different in Records (List name shown in records) Record of Death Found (Complete a and b) a. Date of Death (mm/dd/yyyy) 5. A. Active Duty Service Records Found (Complete A through F) Branch of Service b. Death resulted from injury or disease incurred in or aggravated by active duty service during a period of military hostilities specified by law? Yes No Unable to Determine B. Date Entered Active Duty (mm/dd/yyyy) 8. Certification I certify the information given here concerning the (Check one or both, as appropriate) Service Death C. Place Entered Active Duty Service (City/State/Country) of the individual named on this form is correct according to the records of the (name below). (Department of Defense Military Branch) D. Service Number E. Date Released From Service (mm/dd/yyyy) Signature Date (mm/dd/yyyy) F. Honorable Service During a Period of Hostilities (If no is checked, please provide an explanation.) Yes No Title Phone Number E-mail Address Form N-644 08/05/15 N Page 3 American LegalNet, Inc. www.FormsWorkFlow.com Part III. To Be Completed by the Department of Defense Official for Appropriate Branch of Military Service B. Unable to Certify Based on the information received from the Department of Veterans Affairs concerning the death of the individual named on this form, I am unable to certify that the individual died as a result of injury or disease incurred in or aggravated by service during a period of hostilities specified by law. A. Certification Based on the information received from the Department of Veterans Affairs concerning the death of the individual named on this form, I certify that the individual died on (Date (mm/dd/yyyy)) as a result of injury or disease incurred in or aggravated by service during a period of hostilities specified by law. Signature Date (mm/dd/yyyy) Signature Date (mm/dd/yyyy) Title Title NOTE: Space below (Part IV) for use by U.S. Citizenship and Immigration Services Only Part IV. To be Completed by U.S. Citizenship and Immigration Services Applicant Authorized Next-of-Kin or Representative Positive Certification Military Service Positive Certification Service Connected Death Place of Enlistment Qualifies Under INA Section 329 (a)(1) Decedent Admitted for Lawful Permanent Residence Cert. # Date Mailed Action Block A# Reg. Mail # Initial Receipt Resubmitted Relocated Rec'd Sent App'd Completed Denied Ret'd Form N-644 08/05/15 N Page 4 American LegalNet, Inc. www.FormsWorkFlow.com