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TABLE OF CHANGES – FORMForm N-600K, Application for Citizenship and Issuance of Certificate Under Section 322

OMB Number: 1615-008704/18/2018

Reason for Revision: Minor revisions, including updates to standard language.

• Black font = Current text• Purple font = Standard language• Red font = Changes

Current Page Numberand Section

Current Text Proposed Text

Page 1, For USCIS UseOnly

[Page 1]

To be completed by an Attorney orAccredited Representative (if any).[ ] Select this box if Form G-28 is attached.Attorney State Bar Number (if applicable)Attorney or Accredited RepresentativeUSCIS Online Account Number (if any)

START HERE - Type or print in black ink.

[Page 1]

To be completed by an Attorney orAccredited Representative (if any).[ ] Select this box if Form G-28 is attached.Attorney State Bar Number (if applicable)Attorney or Accredited RepresentativeUSCIS Online Account Number (if any)

START HERE - Type or print in black ink.

NOTE: The applicant on this form is thechild’s parent, grandparent, or legal guardian.

Page 1, Part 1.Information About theChild’s Eligibility

[Page 1]

Part 1. Information About the Child’sEligibility

1. The application is being filed for a child. Thechild is under 18 years of age and (Select onlyone box):

The BIOLOGICAL child of a qualifying U.S.citizen (USC) parent filing this application.

The ADOPTED child of a qualifying USCparent filing this application.

The grandchild of a qualifying USCgrandparent or the child ward of a USC legalguardian filing this application within five yearsof the death of the USC parent.

[Page 1]

Part 1. Information About the Child’sEligibility

1. The application is being filed for a child. Thechild is under 18 years of age and (select onlyone box):

The BIOLOGICAL child of a qualifying U.S.citizen (USC) parent filing this application.

The ADOPTED child of a qualifying USCparent filing this application.

The grandchild of a qualifying USCgrandparent or the child ward of a USC legalguardian filing this application within five yearsof the death of the USC parent.

Page 1, Part 2.Information About theChild

[Page 1]

Part 2. Information About the Child (forwhom this application being filed)

1. Current Legal Name (do not provide anickname)

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Part 2. Information About the Child (forwhom this application being filed)

1. Current Legal Name (do not provide anickname)

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Family Name (Last Name)Given Name (First Name)Middle Name

2. Your Name Exactly As It Appears on thePermanent Resident Card (if applicable)Family Name (Last Name)Given Name (First Name)Middle Name

3. Other Names Used (if applicable)

Provide all other names you have ever used,including nicknames, maiden name, and aliases.Family Name (Last Name)Given Name (First Name)Middle Name

4. U.S. Social Security Number (if applicable)5. USCIS Online Account Number (if any)6. Date of Birth (mm/dd/yyyy)7. Country of Birth

[Page 2]

8. Prior Country of Citizenship or Nationality9. Gender Male/Female10. Height Feet/Inches

11. Mailing AddressIn Care Of Name (if any)Street Number and NameApt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal CodeCountry

12. Physical Address (Do not provide a POBox in this space unless it is the ONLYaddress.)Street Number and NameApt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal CodeCountry

13. Marital StatusSingle, Never MarriedMarriedDivorcedWidowedSeparatedMarriage AnnulledOther (Explain): _______

Family Name (Last Name)Given Name (First Name)Middle Name

2. Name Exactly As It Appears on thePermanent Resident Card (if applicable)Family Name (Last Name)Given Name (First Name)Middle Name

3. Other Names Used (if applicable)

Provide all other names ever used, includingnicknames, maiden name, and aliases.Family Name (Last Name)Given Name (First Name)Middle Name

4. U.S. Social Security Number (if applicable)5. USCIS Online Account Number (if any)6. Date of Birth (mm/dd/yyyy)7. Country of Birth

[Page 2]

8. Country of Citizenship or Nationality9. Gender Male/Female10. Height Feet/Inches

11. Mailing AddressIn Care Of Name (if any)Street Number and NameApt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal CodeCountry

12. Physical Address (Do not provide a POBox in this space unless it is the ONLYaddress.)Street Number and NameApt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal CodeCountry

13. Marital StatusSingle, Never MarriedMarriedDivorcedWidowedSeparatedMarriage AnnulledOther (Explain): _______

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14. Information About the Admission Into theUnited States and Current Immigration Status

NOTE: Do NOT complete this section. TheUSCIS officer will complete it during theinterview.

A. Port-of-EntryCity or TownStateDate of Entry (mm/dd/yyyy)

Exact Name Used at Time of EntryFamily Name (Last Name)Given Name (First Name)Middle Name

B. Current Immigration Status

15. Was there any prior application forcitizenship or for a U.S. passport? Y/N

[Page 3]

16. Was the child adopted? Y/N

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 eachother when the child was born (or adopted)?Y/N

14. Information About the Child’s AdmissionInto the United States and Current ImmigrationStatus

NOTE: Do NOT complete this section. TheUSCIS officer will complete it during theinterview.

A. Port-of-EntryCity or TownStateDate of Entry (mm/dd/yyyy)

Exact Name Used at Time of EntryFamily Name (Last Name)Given Name (First Name)Middle Name

B. Current Immigration Status

15. Was there any prior application forcitizenship or for a U.S. passport? Y/N

[Page 3]

16. Was the child adopted? Y/N

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 eachother when the child was born (or adopted)?Y/N

Page 3, Part 3.Information About theChild’s U.S. CitizenBiological or AdoptiveParent

[Page 3]

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 ofthe eligible child. Provide information aboutthe child's U.S. citizen parent in the sectionsnoted if the U.S. citizen grandparent or legalguardian is filing this form.

1. Current Legal Name of U.S. Citizen ParentFamily Name (Last Name)Given Name (First Name)Middle Name

2. Date of Birth (mm/dd/yyyy)3. Country of Birth4. U.S. Social Security Number (if applicable)

5. Physical AddressStreet Number and Name (Do not provide a POBox in this space unless it is your ONLYaddress.)

[Page 3]

[no change]

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Apt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal CodeCountry

6. Daytime Telephone Number7. Work Telephone Number (if any)8. Evening Telephone Number9. Mobile Telephone Number (if any)10. Email Address (if any)

[Page 4]

11. The parent is a U.S. citizen by:Birth in the United States

Acquisition after birth through naturalization ofalien parents

Birth abroad to U.S. citizen parentsCertificate of Citizenship NumberAlien Registration Number (A-Number) (ifknown)

Naturalization

Place of NaturalizationName of Court or USCIS Office LocationCity or TownStateCertificate of Naturalization NumberA-Number (if known)

Date of Naturalization (mm/dd/yyyy)

12. Has the U.S. citizen father or mother everlost U.S. citizenship or taken any action thatwould cause loss of U.S. citizenship? Y/N

If the answer is “Yes” to Item Number 12.,provide a full explanation in the space providedin Part 11. Additional Information.

13. Marital History

A. How many times has the U.S. citizen fatheror mother been married (including annulledmarriages and marriages to the same person)?

B. What is the U.S. citizen father or mother'scurrent marital status?

Single, Never MarriedMarriedDivorcedWidowedSeparatedMarriage AnnulledOther (Explain): _______

Acquisition After Birth Through Naturalizationof Alien Parent(s)

Birth Abroad to U.S. Citizen Parent(s)Certificate of Citizenship Number (if any)Alien Registration Number (A-Number) (if any)

Naturalization

Place of NaturalizationName of Court or USCIS Office LocationCity or TownStateCertificate of Naturalization NumberA-NumberDate of Naturalization (mm/dd/yyyy)

12. Has the U.S. citizen father or mother everlost U.S. citizenship or taken any action thatwould cause loss of U.S. citizenship? Y/N

If you answered “Yes” to Item Number 12.,provide a full explanation in the space providedin Part 11. Additional Information.

13. Marital History

A. How many times has the U.S. citizen fatheror mother been married (including annulledmarriages and marriages to the same person)?

B. What is the U.S. citizen father or mother'scurrent marital status?

Single, Never MarriedMarriedDivorcedWidowedSeparatedMarriage AnnulledOther (Explain): _______

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C. Information About the U.S. Citizen Father'sor Mother's Current SpouseFamily Name (Last Name)Given Name (First Name)Middle Name

Date of Birth (mm/dd/yyyy)Country of BirthCountry of Citizenship or Nationality

Spouse's Physical AddressStreet Number and Name (Do not provide a POBox in this space unless it is your spouse'sONLY address.)Apt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal CodeCountry

[Page 5]

Date of Marriage (mm/dd/yyyy)

Place of MarriageCity or TownStateCountry

Spouse's Immigration StatusU.S. CitizenLawful Permanent ResidentOther (Explain): ____________

D. Is the U.S. citizen father's or mother'scurrent spouse also the child's biological (oradoptive) parent? Y/N

14. Member of U.S. Armed Forces

A. Is the sponsoring U.S. citizen parent amember of the U.S. Armed Forces? Y/N

B. If the answer is “Yes,” then are thereofficial orders authorizing the child toaccompany and reside with the sponsoring U.S.citizen parent who is a member of the U.S.Armed Forces? Y/N

NOTE: If the U.S. citizen biological oradoptive parent is filing this application ANDhas the required physical presence in theUnited States, skip Part 4. and go directly toPart 5.

[no change]

14. Member of U.S. Armed Forces

A. Is the sponsoring U.S. citizen parent amember of the U.S. Armed Forces? Y/N

B. If you answered “Yes” to Item A., then arethere official orders authorizing the child toaccompany and reside with the sponsoring U.S.citizen parent who is a member of the U.S.Armed Forces? Y/N

NOTE: If the U.S. citizen biological oradoptive parent is filing this application ANDhas the required physical presence in theUnited States, skip Part 4. and go directly toPart 5.

Page 5, Part 4.Information About the

[Page 5]

Part 4. Information About the Child’s

[Page 5]

[no change]

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Child’s Qualifying U.S.Citizen Grandparent

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 forthe child, and the U.S. citizen parent has notbeen physically present in the United States forfive years; two years of which were after 14years of age.)

1. Current Legal Name of U.S. CitizenGrandparentFamily Name (Last Name)Given Name (First Name)Middle Name

2. Date of Birth (mm/dd/yyyy)3. Country of Birth4. U.S. Social Security Number (if applicable)

5. Physical Address

Street Number and Name (Do not provide a POBox in this space unless it is your ONLYaddress.)Apt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal CodeCountry

6. Daytime Telephone Number7. Work Telephone Number (if any)

[Page 6]

8. Evening Telephone Number9. Mobile Telephone Number (if any)10. Email Address (if any)

11. The grandparent is a U.S. citizen by:Birth in the United StatesAcquisition after birth through naturalization ofalien parents

Birth abroad to U.S. citizen parents

Certificate of Citizenship NumberA-Number (if known)

Naturalization

Place of NaturalizationName of Court or USCIS Office LocationCity or TownState

Certificate of Naturalization Number

11. The grandparent is a U.S. citizen by:Birth in the United StatesAcquisition After Birth Through Naturalizationof Alien Parent(s)

Birth Abroad to U.S. Citizen Parent(s)

Certificate of Citizenship Number (if any)A-Number (if any)

Naturalization

Place of NaturalizationName of Court or USCIS Office LocationCity or TownState

Certificate of Naturalization Number

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A-Number (if known)Date of Naturalization (mm/dd/yyyy

12. Has the grandparent ever lost U.S.citizenship or taken any action that would causeloss of U.S. citizenship? Y/N

If the answer is “Yes” to Item Number 12.,provide a full explanation in the space providedin Part 11. Additional Information.

A-NumberDate of Naturalization (mm/dd/yyyy)

12. Has the grandparent ever lost U.S.citizenship or taken any action that would causeloss of U.S. citizenship? Y/N

If you answered “Yes” to Item Number 12.,provide a full explanation in the space providedin Part 11. Additional Information.

Page 6, Part 5. PhysicalPresence in the UnitedStates From Birth UntilFiling of Form N-600K

[Page 6]

Part 5. Physical Presence in the UnitedStates From Birth Until Filing of Form N-600K

NOTE: Provide the dates that the U.S. citizenparent or grandparent was present in the UnitedStates. If the U.S. citizen parent has not beenphysically present in the United States for fiveyears, two years of which were after 14 years ofage, then the child must use the physicalpresence of the U.S. citizen grandparent.

1. Indicate whether this information relates tothe U.S. citizen parent or to the qualifyinggrandparent.U.S. Citizen ParentU.S. Citizen Grandparent

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)

NOTE: If the U.S. citizen biological/adoptiveparent is filing this application, skip Part 6.and go directly to Part 7.

[Page 6]

[no change]

Page 7, Part 6.Information About theLegal Guardian

[Page 7]

Part 6. Information About the LegalGuardian

NOTE: Complete this part only if your legalguardian is filing this application in lieu of adeceased U.S. citizen parent.

1. Current Legal Name of U.S. CitizenGrandparent

Family Name (Last Name)Given Name (First Name)

[Page 7]

Part 6. Information About the LegalGuardian

NOTE: Complete this part only if the legalguardian is filing this application on behalf of adeceased U.S. citizen parent.

[no change]

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Middle Name

2. Date of Birth (mm/dd/yyyy)3. Country of Birth4. U.S. Social Security Number (if applicable)

5. Physical AddressStreet Number and Name (Do not provide a POBox in this space unless it is your ONLYaddress.)Apt. Ste. Flr. NumberCity or TownStateZIP Code ProvincePostal CodeCountry

6. Daytime Telephone Number7. Work Telephone Number (if any)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 ofalien parents

Birth abroad to U.S. citizen parents

Certificate of Citizenship NumberA-Number (if known)

Naturalization

Place of NaturalizationName of Court or USCIS Office LocationCity or TownState

Certificate of Naturalization NumberA-Number (if known)

Date of Naturalization (mm/dd/yyyy

[Page 8]

12. Date of Legal Guardianship (mm/dd/yyyy)

13. Name of Authority that Granted Legal

Guardianship

14. Address of Authority that Granted LegalGuardianshipStreet Number and Name (Do not provide a POBox in this space unless it is your ONLYaddress.)Apt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal Code

11. The legal guardian is a U.S. citizen by:Birth in the United StatesAcquisition After Birth Through Naturalizationof Alien Parent(s)

Birth Abroad to U.S. Citizen Parent(s)

Certificate of Citizenship Number (if any)A-Number (if any)

Naturalization

Place of NaturalizationName of Court or USCIS Office LocationCity or TownState

Certificate of Naturalization NumberA-NumberDate of Naturalization (mm/dd/yyyy)

[no change]

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Country

Page 8, Part 7. PreferredLocation and Date forInterview

[Page 8]

Part 7. Preferred Location and Date forInterview

1. USCIS Office LocationCity or TownState

2. Preferred Date (mm/dd/yyyy)

USCIS will attempt to accommodate therequested preferences.

NOTE: Interview date should be at least 90days after filing Form N-600K and before thechild's 18th birthday.

[Page 8]

Part 7. Preferred Location and Date forInterview

1. USCIS Office LocationCity or TownState

2. Preferred Date (mm/dd/yyyy)

USCIS will attempt to accommodate therequested preferences.

NOTE: The interview date should be at least90 days after filing Form N-600K and beforethe child's 18th birthday.

Page 8, Part 8.Applicant’s Statement,Contact Information,Certification, andSignature

[Page 8]

Part 8. Applicant’s Statement, ContactInformation, Certification, and Signature

NOTE: Read the Penalties section of the FormN-600K Instructions before completing thispart.

Applicant’s StatementNOTE: Select the box for either Item A. or B.in Item Number 1. If applicable, select the boxfor Item Number 2.

1. Applicant's Statement Regarding theInterpreter

A. I can read and understand English, and Ihave read and understand every question andinstruction on this application and my answer toevery question.

B. The interpreter named in Part 9. read to meevery question and instruction on thisapplication and my answer to every question in

___________, a language in which I amfluent, and I understood everything.

2. Applicant's Statement Regarding thePreparer

At my request, the preparer named in Part 10.,_________, prepared this application for mebased only upon information I provided orauthorized.

[Page 9]

Applicant’s Contact Information3. Applicant's Daytime Telephone Number4. Applicant's Mobile Telephone Number (if

[Page 8]

Part 8. Applicant’s Statement, Declaration,Certification, and Signature

NOTE: Read the Penalties section of the FormN-600K Instructions before completing thissection.

Applicant’s StatementNOTE: Select the box for either Item A. or B.in Item Number 1. If applicable, select the boxfor Item Number 2.

1. Applicant's Statement Regarding theInterpreter

A. I can read and understand English, and Ihave read and understand every question andinstruction on this application and my answer toevery question.

B. The interpreter named in Part 9. read to meevery question and instruction on thisapplication and my answer to every question in

___________, a language in which I amfluent, and I understood everything.

2. Applicant's Statement Regarding thePreparer

At my request, the preparer named in Part 10.,_________, prepared this application for mebased only upon information I provided orauthorized.

[Page 9]

[deleted]

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any)5. Applicant's Email Address (if any)

Applicant’s CertificationCopies of any documents I have submitted areexact photocopies of unaltered, originaldocuments, and I understand that USCIS mayrequire that I submit original documents toUSCIS at a later date. Furthermore, I authorizethe release of any information from any of myrecords that USCIS may need to determine myeligibility for the immigration benefit I seek.

I further authorize release of informationcontained in this application, in supportingdocuments, and in my USCIS records to otherentities and persons where necessary for theadministration and enforcement of U.S.immigration laws.

I understand that USCIS may require me toappear for an appointment to take mybiometrics (fingerprints, photograph, and/orsignature) and, at that time, if I am required toprovide biometrics, I will be required to sign anoath reaffirming that:

1) I reviewed and provided or authorized all ofthe information in my application;

2) I understood all of the information containedin, and submitted with, my application; and

3) All of this information was complete, true,and correct at the time of filing.

I certify, under penalty of perjury, that Iprovided or authorized all of the information inmy application, I understand all of theinformation contained in, and submitted with,my application, and that all of this informationis complete, true, and correct.

Applicant’s Signature6. Applicant’s Signature (sign in ink)Date of Signature (mm/dd/yyyy)

NOTE TO ALL APPLICANTS: If you donot completely fill out this application or fail tosubmit required documents listed in theInstructions, USCIS may deny your application.

Applicant’s Declaration and CertificationCopies of any documents I have submitted areexact photocopies of unaltered, originaldocuments, and I understand that USCIS mayrequire that I submit original documents toUSCIS at a later date. Furthermore, I authorizethe release of any information from any and allof my records that USCIS may need todetermine my eligibility for the immigrationbenefit I seek.

I further authorize release of informationcontained in this application, in supportingdocuments, and in my USCIS records, to otherentities and persons where necessary for theadministration and enforcement of U.S.immigration law.

[deleted]

I certify, under penalty of perjury, that all of theinformation in my application, and anydocument submitted with it were provided orauthorized by me, that I reviewed andunderstand all of the information contained in,and submitted with, my application, and that allof this information is complete, true, andcorrect.

Applicant’s Signature3. Applicant’s Signature (sign in ink)Date of Signature (mm/dd/yyyy)

NOTE TO ALL APPLICANTS: If you donot completely fill out this application or fail tosubmit required documents listed in theInstructions, USCIS may deny your application.

Page 9, Part 9.Interpreter’s ContactInformation,Certification, andSignature

[Page 9]

Part 9. Interpreter’s Contact Information,Certification, and Signature

Provide the following information about the

[Page 9]

Part 9. Interpreter’s Contact Information,Certification, and Signature

Provide the following information about the

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interpreter.

Interpreter’s Full Name1. Interpreter's Family Name (Last Name)Interpreter's Given Name (First Name)2. Interpreter's Business or Organization Name(if any)

[Page 10]

Interpreter’s Mailing Address

3. Street Number and NameApt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal CodeCountry

Interpreter’s Contact Information4. Interpreter’s Daytime Telephone Number5. Interpreter’s Mobile Telephone Number (ifany)6. Interpreter’s Email Address (if any)

Interpreter’s CertificationI certify, under penalty of perjury, that:

I am fluent in English and ________, which isthe same language specified in Part 8., Item B.in Item Number 1., and I have read to thisapplicant in the identified language everyquestion and instruction on this application andhis or her answer to every question. Theapplicant informed me that he or sheunderstands every instruction, question, andanswer on the application, including theApplicant's Certification, and has verified theaccuracy of every answer.

Interpreter’s Signature7. Interpreter’s Signature (sign in ink)Date of Signature (mm/dd/yyyy)

interpreter.

Interpreter’s Full Name1. Interpreter's Family Name (Last Name)Interpreter's Given Name (First Name)2. Interpreter's Business or Organization Name(if any)

[Page 10]

Interpreter’s Mailing Address

3. Street Number and NameApt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal CodeCountry

Interpreter’s Contact Information4. Interpreter’s Daytime Telephone Number5. Interpreter’s Mobile Telephone Number (ifany)6. Interpreter’s Email Address (if any)

Interpreter’s CertificationI certify, under penalty of perjury, that:

I am fluent in English and ________, which isthe same language specified in Part 8., Item B.in Item Number 1., and I have read to thisapplicant in the identified language everyquestion and instruction on this application andhis or her answer to every question. Theapplicant informed me that he or sheunderstands every instruction, question, andanswer on the application, including theApplicant's Declaration and Certification,and has verified the accuracy of every answer.

Interpreter’s Signature7. Interpreter’s Signature (sign in ink)Date of Signature (mm/dd/yyyy)

Page 10, Part 10.Contact Information,Declaration, andSignature of the PersonPreparing thisApplication, if OtherThan the Applicant

[Page 10]

Part 10. Contact Information, Declaration,and Signature of the Person Preparing thisApplication, if Other Than the Applicant

Provide the following information about thepreparer.

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)

[Page 10]

Part 10. Contact Information, Declaration,and Signature of the Person Preparing thisApplication, if Other Than the Applicant

Provide the following information about thepreparer.

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)

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[Page 11]

Preparer’s Mailing Address3. Street Number and NameApt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal CodeCountry

Preparer’s Contact Information4. Preparer’s Daytime Telephone Number5. Preparer’s Mobile Telephone Number (ifany)6. Preparer’s Email Address (if any)

Preparer’s Statement7.A. I am not an attorney or accreditedrepresentative but have prepared thisapplication on behalf of the applicant and withthe applicant's consent.

B. I am an attorney or accredited representativeand my representation of the applicant in thiscase extends/does not extend beyond thepreparation of this application.

NOTE: If you are an attorney or accreditedrepresentative whose representation extendsbeyond preparation of this application, you maybe obliged to submit a completed Form G-28,Notice of Entry of Appearance as Attorney orAccredited Representative, with thisapplication.

Preparer’s CertificationBy my signature, I certify, under penalty ofperjury, that I prepared this application at therequest of the applicant. The applicant thenreviewed this completed application andinformed me that he or she understands all ofthe information contained in, and submittedwith, his or her application, including theApplicant's Certification, and that all of thisinformation is complete, true, and correct. Icompleted this application based only oninformation that the applicant provided to me orauthorized me to obtain or use.

Preparer’s Signature7. Preparer’s Signature (sign in ink)Date of Signature (mm/dd/yyyy)

[Page 11]

Preparer’s Mailing Address3. Street Number and NameApt. Ste. Flr. NumberCity or TownStateZIP CodeProvincePostal CodeCountry

Preparer’s Contact Information4. Preparer’s Daytime Telephone Number5. Preparer’s Mobile Telephone Number (ifany)6. Preparer’s Email Address (if any)

Preparer’s Statement7.A. I am not an attorney or accreditedrepresentative but have prepared thisapplication on behalf of the applicant and withthe applicant's consent.

B. I am an attorney or accredited representativeand my representation of the applicant in thiscase extends/does not extend beyond thepreparation of this application.

NOTE: If you are an attorney or accreditedrepresentative whose representation extendsbeyond preparation of this application, you mayalso need to submit a completed Form G-28,Notice of Entry of Appearance as Attorney orAccredited Representative, or Form G-28I,Notice of Entry of Appearance as Attorney InMatters Outside the Geographical Confines ofthe United States, with this application.

Preparer’s CertificationBy my signature, I certify, under penalty ofperjury, that I prepared this application at therequest of the applicant. The applicant thenreviewed this completed application andinformed me that he or she understands all ofthe information contained in, and submittedwith, his or her application, including theApplicant's Declaration and Certification,and that all of this information is complete, true,and correct. I completed this application basedonly on information that the applicant providedto me or authorized me to obtain or use.

Preparer’s Signature7. Preparer’s Signature (sign in ink)Date of Signature (mm/dd/yyyy)

Page 12, Part 11.Additional Information

[Page 12]

Part 11. Additional Information

[Page 12]

Part 11. Additional Information

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If you need extra space to provide anyadditional information within this application,use the space below. If you need more spacethan what is provided, make copies of this pageto complete and file with this application orattach a separate sheet of paper. Type or printthe applicant's name and A-Number (if any) atthe top of each sheet; indicate the PageNumber, Part Number, and Item Number towhich the answer refers; and sign and date eachsheet.

1. Family Name (Last Name)Given Name (First Name)Middle Name

2. A-Number (if any)

3. A. Page NumberB. Part NumberC. Item NumberD. __________________

4. A. Page NumberB. Part NumberC. Item NumberD. __________________

5. A. Page NumberB. Part NumberC. Item NumberD. __________________

6. A. Page NumberB. Part NumberC. Item NumberD. __________________

7. A. Page NumberB. Part NumberC. Item NumberD. __________________

If you need extra space to provide anyadditional information within this application,use the space below. If you need more spacethan what is provided, make copies of this pageto complete and file with this application orattach a separate sheet of paper. Type or printthe child’s name and A-Number (if any) at thetop of each sheet; indicate the Page Number,Part Number, and Item Number to which theanswer refers; and sign and date each sheet.

1. Family Name (Last Name)Given Name (First Name)Middle Name

2. A-Number (if any)

3. A. Page NumberB. Part NumberC. Item NumberD. __________________

4. A. Page NumberB. Part NumberC. Item NumberD. __________________

5. A. Page NumberB. Part NumberC. Item NumberD. __________________

6. A. Page NumberB. Part NumberC. Item NumberD. __________________

7. A. Page NumberB. Part NumberC. Item NumberD. __________________

Page 13, Part 12.Affidavit

[Page 13]

Part 12. Affidavit (At the time of Interview)

I, the parent/grandparent/legal guardian,___________ do swear or affirm, under penaltyof perjury under the laws of the United States,that I know and understand the contents of thisapplication signed by me, and the attachedsupplementary pages number ___ to ___inclusive, that the same are true and correct tothe best of my knowledge, and that correctionsnumber ____ to ____ were made by me or atmy request.

Applicant's, Parent's, or Grandparent's or LegalGuardian's Signature (sign in ink)

[Page 13]

Part 12. Affidavit (At the time of Interview)

I, the parent/grandparent/legal guardian,___________ do swear or affirm, under penaltyof perjury under the laws of the United States,that I know and understand the contents of thisapplication signed by me, and the attachedsupplementary pages number ___ to ___inclusive, that the same are true and correct tothe best of my knowledge, and that correctionsnumber ____ to ____ were made by me or atmy request.

Parent’s, Grandparent’s, or Legal Guardian’sSignature (sign in ink)

AILA Doc. No. 18050733. (Posted 5/7/18)

14

Date of Signature (mm/dd/yyyy)

Subscribed and sworn or affirmed before meupon examination of the applicant (U.S. citizenparent, grandparent, or legal guardian) on (Date(mm/dd/yyyy)) _______ at (Location).

Interviewing USCIS Officer’s NameInterviewing USCIS Officer’s TitleInterviewing USCIS Officer’s Signature (signin ink)Date of Signature (mm/dd/yyyy)

Date of Signature (mm/dd/yyyy)

Subscribed and sworn or affirmed before meupon examination of the applicant (U.S. citizenparent, grandparent, or legal guardian) on (Date(mm/dd/yyyy)) _______ at (Location).

Interviewing USCIS Officer’s NameInterviewing USCIS Officer’s TitleInterviewing USCIS Officer’s Signature (signin ink)Date of Signature (mm/dd/yyyy)

Page 13, Part 13. USCISOfficer Report andRecommendation

[Page 13]

Part 13. USCIS Officer Report andRecommendation

On the basis of the documents, records and thetestimony of person examined, and theidentification upon personal appearance of theunderage beneficiary, I find that all the factsand conclusions set forth under oath in thisapplication are:

1. True and correct;2. The applicant derived or acquired U.S.citizenship on (Date (mm/dd/yyyy))

3. The applicant derived or acquired U.S.citizenship through (Select the box next to theappropriate section of law or, if the section oflaw is not reflected, type or print the applicablesection of law in the space next to “Other.”)

A. INA Section 322(a)(2)(A) of the (Parentresidence);B. INA Section 322(a)(2)(B) of the(Grandparent residence); orC. Other

I recommend that this Form N-600K be:Approved/Denied

Issue Certificate of Citizenship in the Name of

Family Name (Last Name)Given Name (First Name)Middle Name

USCIS Officer's Printed NameUSCIS Officer’s TitleUSCIS Officer’s Signature (sign in ink)Date of Signature (mm/dd/yyyy)

I do/do not concur with the USCIS officer’srecommendation of the Form N-600K.

USCIS Field Office Director’s Signature (signin ink)Date of Signature (mm/dd/yyyy)

[Page 13]

[no change]

AILA Doc. No. 18050733. (Posted 5/7/18)

15AILA Doc. No. 18050733. (Posted 5/7/18)