Form N-644 - Application For Posthumous Citizenship

Form N-644 - Application For Posthumous Citizenship - Uscis Page 4

Part III. To Be Completed by the Department of Defense Official for Appropriate Branch of Military

Service

A. Certification

B. Unable to Certify

Based on the information received from the Department

Based on the information received from the Department of

of Veterans Affairs concerning the death of the individual

Veterans Affairs concerning the death of the individual

named on this form, I certify that the individual died on

named on this form, I am unable to certify that the individual

as a result of injury or

died as a result of injury or disease incurred in or aggravated

(Date

)

(mm/dd/yyyy)

disease incurred in or aggravated by service during a period

by service during a period of hostilities specified by law.

of hostilities specified by law.

Signature

Date

(mm/dd/yyyy)

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

Action Block

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

A #

Reg. Mail #

Initial Receipt Resubmitted

Relocated

Completed

Rec'd

Sent

App'd

Denied

Ret'd

Form N-644 08/05/15 N Page 4

Form N-644 - Application For Posthumous Citizenship - Uscis Page 4