Form N-426 Request for Certification of Military or Naval Service

Request for Certification
of Military or Naval Service

USCIS
Form N-426

Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0053
Expires 08/31/2017

Persons who are serving or have served under specified conditions in the U.S. Armed Forces 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.
USCIS requests certification of the service member's military service. Recruiters are not authorized to certify this request. Submit
this request with Form N-400, Application for Naturalization.
Instructions: Requestors must complete Parts 1. - 4. Certifying officials must complete Parts 5. - 8.

Part 1. Information About You
1.

Alien Registration Number (A-Number) (if any)

2.

Military Service Number

► A-

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3.

Names Used During Military Service

List all names you have used, including your maiden name (if any). If you need extra space to complete this section, use the
space provided in Part 9. Additional Information.
Family Name (Last Name)

Given Name (First Name)

4.

U.S. Social Security Number (if any) 5.
►

7.

Place of Birth (city and country)

8.

Physical Address

USCIS ELIS Account Number (if any)
►

Middle Name

6.

Date of Birth (mm/dd/yyyy)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

County

State

ZIP Code + 4
-

Province or Region (foreign address only)

Country (foreign address only)

Postal Code (foreign address only)

Part 2. Enlistment Information
1.

Where did you enlist?
City

2.

Have you reenlisted?

3.

Where did you reenlist?
City

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Yes

State

Country

State

Country

No

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Part 3. Periods of Military Service (To be completed by requestor)
Provide all periods of service. If you need extra space to complete this section, use the space provided in Part 9. Additional
Information.
Military Service

Branch of Service

Date Service
Began
(mm/dd/yyyy)

Date Service
Ended
(mm/dd/yyyy)

Type of Service (include all active, reserve,
and National Guard Service)
Active Duty
Selected Reserve of the Ready Reserve*
Active Duty
Selected Reserve of the Ready Reserve*
Active Duty
Selected Reserve of the Ready Reserve*

Military Service 1
Military Service 2
Military Service 3

* 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 a 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)

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Part 4. Requestor's Contact Information, Certification, and Signature

Requestor's Contact Information

1.

Requestor's Daytime Telephone Number

3.

Requestor's Email Address (if any)

2.

Requestor's Mobile Telephone Number (if any)

Requestor's Certification

I authorize release of information contained in this request, in supporting documents, and in my USCIS records to other entities and
persons where necessary for the administration and enforcement of U.S. immigration laws.

I certify, under penalty of perjury, that all of the information in my request and any document submitted with it were provided by me
and are complete, true, and correct.

Requestor's Signature

4.

Requestor's Signature

Date of Signature (mm/dd/yyyy)

NOTE TO ALL REQUESTORS: USCIS may deny your request if you do not completely fill out this request or fail to submit
required documents listed in the Instructions.

Part 5. Character of Service (To be completed by Certifying Official)
State whether the requestor served honorably or is currently serving honorably for each period of military service the requestor served
(refer to Part 3. Periods of Military Service). If you answer “No,” provide details in Part 7. Remarks.
1.

Honorable Period of Military Service 1

Yes

No

2.

Honorable Period of Military Service 2

Yes

No

3.

Honorable Period of Military Service 3

Yes

No

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Part 6. Separation Information
1.

Is the requestor separated?

2.

If separated, select discharge type:

3.

Was the requestor discharged on account of alienage?

No

Yes
Honorable

Other (provide details in Part 7. Remarks)
Yes

No

If you answer “Yes,” provide details in Part 7. Remarks.

Part 7. Remarks
Provide any derogatory information in your records relating to the service member's character, loyalty to the United States,
disciplinary action, convictions, other than honorable discharges, or other matters concerning his or her fitness for citizenship. If you
need extra space to complete this section, use the space provided in Part 9. Additional Information.

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Part 8. 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 request is correct
according to the records of the

Name of Department

Official Signature

Name and Title

Daytime Telephone Number

Email Address (if any)

Date (mm/dd/yyyy)

Seal, if available (No state-issued
notary public seals accepted.)

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Part 9. Additional Information
If you need extra space to provide any additional information within this request, use the space below. If you need more space than
what is provided, you may make copies of this page to complete and file with this request or attach a separate sheet of paper. Include
your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which
your answer refers; and sign and date each sheet.
1.

Family Name (Last Name)

Given Name (First Name)

2.

A-Number (if any) ► A-

3.

A. Page Number

B. Part Number

Middle Name

C. Item Number

D.

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4.

A. Page Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

D.

5.

A. Page Number

D.

6.

A. Page Number

D.

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