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1345 Avenue of the Americas, 2nd Floor
New York, NY 10105
ken
garcia
attorney at law
_________________________________
Immigration & Nationality Law
FREE CONSULTATION
N-400 QUESTIONNAIRE
Please answer all questions completely and truthfully.
If a required field is not applicable, please write N/A or NA.
The information collected will be used to prepare the naturalization application, will be kept entirely confidential and will not be disclosed to anyone without the client’s consent.
PART I. PERSONAL INFORMATION
1. Complete Name (LAST, First, Middle):
*
2. Name as it exactly appears on your Permanent Resident Card, if applicable:
*
3. Other Names Used, if applicable:
*
4. Naturalization allows the applicant to legally change his/her name. If you like to legally change your name, print the new name you would like to use (LAST, First, Middle):
*
6. Daytime Phone Number:
*
7. Mobile Phone Number:
*
8. Email:
*
9. Date of Birth (mm/dd/yyyy):
*
10. City of Birth:
*
11. Country of Birth:
*
12. Country of Citizenship:
*
13. A-Number:
*
Write "N/A" if Petitioner is a US Citizen
14. U.S. Social Security Number, if any: (If you prefer to not send this sensitive information over this questionnaire, please indicate so on the box below and an alternative arrangement will be made to collect such data.)
*
Write "N/A" if not applicable.
15. Date you became a permanent resident (mm/dd/yyyy):
*
Write "N/A" if not applicable.
16. Port-of-entry or USCIS office where status was adjusted to permanent resident:
*
17. Civil Status:
*
Single
Married
Separated
DIvorced
Widowed
Marriage Annulled
18. Sex:
*
Male
Female
19. Height:
*
20. Weight:
*
21. Are you Hispanic or Latino?
*
Yes
No
22. Race:
*
White
Asian
Black or African American
American Indian
Alaska Native
Native Hawaiian or Other Pacific Islander
23. Hair Color:
*
Black
Brown
Blonde
Gray
White
Red
Sandy
Bald (No Hair)
24. Eye Color:
*
Brown
Blue
Green
Hazel
Gray
Black
Pink
Maroon
Other
25. Are you requesting an accommodation to the naturalization process because of a disability and/or an impairment?
*
Yes
No
25(a). If yes, describe the disability or impairment:
*
26. Are you a permanent resident child of a U.S. citizen parent(s)?
*
Yes
No/Not Applicable
26(a). If yes, complete the following, otherwise, skip to Part II:
25(a)(i). Complete Name of one U.S. Citizen Parent (LAST, First, Middle):
*
26(a)(ii). Complete Address of the U.S. Citizen Parent:
*
Line 1
Line 2
City
State
Zip Code
Country
26(a)(iii). The U.S. Citizen parent is the applicant's:
*
Natural parent
Adoptive parent
Parent of child legitimized after birth
26(a)(iv). U.S. Citizen parent's citizenship was acquired:
*
By birth in the United States
Through naturalization
26(a)(v). If parent is a a naturalized U.S. Citizen, provide the Certificate of Naturalization Number:
*
26(a)(vi). Does the U.S. Citizen parent have legal custody of you?
*
Yes
No
PART II. CURRENT SPOUSAL INFORMATION, IF APPLICABLE
1. Complete Name of Spouse (LAST, First, Middle):
*
2. Other Names Used, if applicable:
*
3. Present Address:
*
Line 1
Line 2
City
State
Zip Code
Country
4. Daytime Phone Number:
*
5. Mobile Phone Number:
*
6. Email:
*
7. Date of Birth (mm/dd/yyyy):
*
8. City of Birth:
*
9. Country of Birth:
*
10. Country of Citizenship:
*
11. Date of Marriage (mm/dd/yyyy):
*
12. Place of Marriage:
*
13. Current Spouse's Immigration Status:
*
U.S. Citizen by birth
U.S. Citizen through naturalization
Lawful Permanent Resident
Other
13(a). If Current Spouse is a naturalized U.S. Citizen, provide the date (mm/dd/yyyy) of naturalization:
*
13(b). If Current Spouse is a Lawful Permanent Resident, provide his/her A-Number:
*
13(b)(i). If Current Spouse is a Lawful Permanent Resident, provide his/her country of citizenship
*
13(c). If Current Spouse's immigration status is "Other," please specify:
*
15. U.S. Social Security Number, if any:
*
16. Current Spouse's Present Employer:
*
PART III. PREVIOUS MARRIAGE INFORMATION
If you or your current spouse were previously married, please provide the following information for all prior marriages:
1. Information About Your Prior Spouse:
1(a). Complete Name of Prior Spouse (LAST, FIrst, Middle):
*
1(b). Date of Marriage to Prior Spouse (mm/dd/yyyy):
*
1(c). Place of Marriage to Prior Spouse:
*
1(d). Date of Termination of Marriage (mm/dd/yyyy):
*
1(e). How did prior marriage end?
*
2. Information About Current Spouse's Former Spouse:
2(a). Complete Name of Prior Spouse (LAST, FIrst, Middle):
*
2(b). Date of Marriage to Prior Spouse (mm/dd/yyyy):
*
2(c). Place of Marriage to Prior Spouse:
*
2(d). Date of Termination of Marriage (mm/dd/yyyy):
*
2(e). How did prior marriage end?
*
PART IV. MISCELLANEOUS INFORMATION
1. List all addresses where you lived during the last 5 years or since becoming a permanent resident, whichever is less.
1(a). Applicant's Present Address:
*
Line 1
Line 2
City
State
Zip Code
Country
1(a)(i). Date (mm/yyyy) the Applicant started residing at the above address:
*
1(b). Previous Address 1:
*
Line 1
Line 2
City
State
Zip Code
Country
1(b)(i). Date the Applicant's residence started and ended at the above address:
*
provide start date (mm/yyyy) and date (mm/yyyy)
1(c). Previous Address 2:
*
Line 1
Line 2
City
State
Zip Code
Country
1(c)(i). Date Applicant's residence started and ended at the above address:
*
provide start date (mm/yyyy) and date (mm/yyyy)
1(d). Previous Address 3:
*
Line 1
Line 2
City
State
Zip Code
Country
1(d)(i). Date Applicant's residence started and ended at the above address:
*
provide start date (mm/yyyy) and end date (mm/yyyy)
2. Information about Applicant's Employment and Schools Attended during the last 5 years.
2(a). Information on Your Current/Most Recent Employment/School:
2(a)(i). Name of Employer/School:
*
2(a)(ii). Address of Employer/School:
*
2(a)(iii). Occupation/Titile:
*
2(a)(iv). Period of Employment/School:
*
Provide start date (mm/yyyy) and end date (mm/yyyy) or "Present," whichever is applicable.
2(b). Information on Your Prior or Second Employment/School:
2(b)(i). Name of Employer/School:
*
2(b)(ii). Address of Employer/School:
*
2(b)(iii). Occupation/Title:
*
2(b)(iv). Period of Employment/School:
*
Provide start date (mm/yyyy) and end date (mm/yyyy) or "Present," whichever is applicable.
2(c). Information on Your Prior Employment/School:
2(c)(i). Name of Employer/School:
*
2(c)(ii). Address of Employer/School:
*
2(c)(iii). Occupation/Title:
*
2(c)(iv). Period of Employment/School:
*
Provide start date (mm/yyyy) and end date (mm/yyyy) or "Present," whichever is applicable.
3. Applicant's absences from the U.S. since becoming a permanent resident. If none, write "none."
3(a). Most recent trip abroad.
3(a)(i). Date of Departure from the U.S. (mm/dd/yyyy):
*
3(a)(ii). Date of Return to the U.S. (mm/dd/yyyy):
*
3(a)(iii). Countries Visited:
*
3(a)(iv). Reason for Trip:
*
3(b). Second most recent trip abroad.
3(b)(i). Date of Departure from the U.S. (mm/dd/yyyy):
*
3(b)(ii). Date of Return to the U.S. (mm/dd/yyyy):
*
3(b)(iii). Countries Visited:
*
3(b)(iv). Reason for Trip:
*
3(c). Third most recent trip abroad.
*
3(c)(i). Date of Departure from the U.S. (mm/dd/yyyy):
*
3(c)(ii). Date of Return to the U.S. (mm/dd/yyyy):
*
3(c)(iii). Countries Visited:
*
3(c)(iv). Reason for Trip:
*
4. Children of the Applicant, if any:
4(a). Child 1:
4(a)(i). Complete Name of First Child (LAST, First, Middle):
*
4(a)(ii). Date of Birth (mm/dd/yyyy):
*
4(a)(iii). Country of Birth:
*
4(a)(iv). Citizenship:
*
4(a)(v). A-Number, if any:
*
Not applicable if child is a U.S. Citizen.
4(a)(vi). Is child living with the Applicant?
*
Yes
No
4(a)(vii). If child is not living with the Applicant, provide child's present address:
*
Line 1
Line 2
City
State
Zip Code
Country
4(b). Child 2:
4(b)(i). Complete Name of Second Child (LAST, First, Middle):
*
4(b)(ii). Date of Birth (mm/dd/yyyy):
*
4(b)(iii). Country of Birth:
*
4(b)(iv). Citizenship:
*
4(b)(v). A-Number, if any:
*
Not applicable if child is a U.S. Citizen.
4(b)(vi). Is child living with the Applicant?
*
Yes
No
4(b)(vii). If child is not living with the Applicant, provide child's present address:
*
Line 1
Line 2
City
State
Zip Code
Country
4(c). Child 3:
4(c)(i). Complete Name of Third Child (LAST, First, Middle):
*
4(c)(ii). Date of Birth (mm/dd/yyyy):
*
4(c)(iii). Country of Birth:
*
4(c)(iv). Citizenship:
*
4(c)(v). A-Number, if any:
*
Not applicable if child is a U.S. Citizen.
4(c)(vi). Is child living with the Applicant?
*
Yes
No
4(c)(vii). If child is not living with the Applicant, provide child's present address:
*
Line 1
Line 2
City
State
Zip Code
Country
4(d). Child 4:
4(d)(i). Complete Name of Fourth Child (LAST, First, Middle):
*
4(d)(ii). Date of Birth (mm/dd/yyyy):
*
4(d)(iii). Country of Birth:
*
4(d)(iv). Citizenship:
*
4(d)(v). A-Number, if any:
*
Not applicable if child is a U.S. Citizen.
4(d)(vi). Is child living with the Applicant?
*
Yes
No
4(d)(vii). If child is not living with the Applicant, provide child's present address:
*
Line 1
Line 2
City
State
Zip Code
Country
PART V. MEMBERSHIPS & ORGANIZATIONS
1. Are you currently a member of any organization, club, or group (including military service)?
*
Yes
No
2. Information on Organizations, if applicable:
2(a). Organization 1:
2(a)(i). Name of Organization:
*
2(a)(ii). Period of Membership:
*
Provide start date (mm/yyyy) and end date (mm/yyyy) or "Present," whichever is applicable.
2(b). Organization 2:
2(b)(i). Name of Organization:
*
2(b)(ii). Period of Membership:
*
Provide start date (mm/yyyy) and end date (mm/yyyy) or "Present," whichever is applicable.
PART VI. ADDITIONAL INFORMATION
1. Have you ever claimed to be a U.S. citizen in any way, shape or form?
*
Yes
No
2. Have you ever registered to vote in any federal, state, or local election in the United States?
*
Yes
No
3. Have you ever voted in any federal, state, or local election in the United States?
*
Yes
No
4. Do you now have, or did you ever have, a hereditary title or an order of nobility in any foreign country?
*
Yes
No
5. Have you ever been declared legally incompetent or been confined to a mental institution?
*
Yes
No
6. Do you owe any overdue federal, state or local taxes?
*
Yes
No
7. Since becoming a Lawful Permanent Resident, have you ever not filed a federal, state or local tax return?
*
Yes
No
8. Since becoming a Lawful Permanent Resident, have you either failed to file a tax return because you considered yourself a "non-U.S. resident?"
*
Yes
No
Not Applicable
9. Have you been a member of, or in any way associated directly or indirectly with the Communist Party, any other totalitarian party or terrorist organization?
*
Yes
No
10. Have you been involved, directly or indirectly, in the overthrow of any government by force or violence?
*
Yes
No
11. Have you been involved, directly or indirectly, in the persecution of any person by reason of race, religion, national origin, membership in a particular social group or political opinion?
*
Yes
No
12. Were you ever involved in any way with any of the following: genocide; torture; killing, or trying to kill, someone; badly hurting, or trying to hurt, a person on purpose; forcing, or trying to force, someone to have any kind of sexual contact or relations; not letting someone practice his/her religion?
*
Yes
No
13. Did you ever provide weapons to any person, or help another person sell, give, or provide weapons to any person?
*
Yes
No
14. Did you ever receive any type of military, paramilitary or weapons training?
*
Yes
No
15. If you answer "Yes" to any of the questions in Nos. 1-14, please use the box below to explain in detail your answer.
*
16. Are you a male who lived in the United States at any time between your 18th and 26th birthdays?
*
Yes
No
Not Applicable
16(a). If "Yes," did you register for the Selective Service?
*
Yes
No
16(a)(i). If you registered, when did you register for the Selective Service (mm/dd/yyyy)?
*
16(a)(ii). If you registered, provide your Selective Service Number:
*
17. Check all that apply:
*
I have committed, assisted in committing, or attempted to commit, a crime or offense for which I was not arrested.
I have been arrested, cited, or detained by any law enforcement officer for any reason.
I have been charged with committing, attempting to commit, or assisting in committing a crime or offense.
I have been convicted of a crime or offense.
I have been placed in an alternative sentencing or rehabilitative program (e.g. diversion, deferred prosecution, withheld adjudication, deferred adjudication).
I have received a suspended sentence, been placed on probation, or been paroled.
I have been in jail or prison.
I have been a habitual drunkard.
I have been a prostitute, or procured anyone for prostitution.
I have sold or smuggled controlled substances, illegal drugs, or narcotics.
I have been married to more than one person at a time.
I have been married to someone in order to obtain an immigration benefit.
I have gambled illegally or received income from illegal gambling.
I have failed to support my dependents or pay alimony.
I have made a misrepresentation to obtain a public benefit in the United States.
I have given false, fraudulent or misleading information or documentation to a U.S. Government official.
I have been removed, excluded, or deported from the United States.
I have been ordered removed, excluded, or deported from the United States.
I have been placed in removal, exclusion, rescission, or deportation proceedings.
Removal, exclusion, rescission, or deportation proceedings (including administratively closed proceedings) are currently pending against me.
I have served in the U.S. Armed Forces.
I am currently a member of the U.S. Armed Forces.
I have been court-martialed, administratively separated, or disciplined, or have received an other than honorable discharge, while in the U.S. Armed Forces.
I have been discharged from training or service in the U.S. Armed Forces because I was an alien.
I have left the United States to avoid being drafted in the U.S Armed Forces.
I have deserted from the U.S. Armed Forces.
None of the above applies.
18. Check all that apply:
*
I support the Constitution and form of government of the United States.
I understand the full Oath of Allegiance to the United States.
I am willing to take the full Oath of Allegiance to the United States.
If the law requires it, I am willing to perform noncombatant services in the U.S. Armed Forces.
If the law requires it, I am willing to perform work of national importance under civilian direction.
Submit