Instructions For Form N-565, Application For Replacement Naturalization
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3OMB No. 1615-0091 Expires 02/28/2015
Instructions for Form N-565, Application for
Department of Homeland Security
Replacement Naturalization/Citizenship Document
U.S. Citizenship and Immigration Services
Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet of paper. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet of
paper and indicate the section and number of the item to which the answer refers.
What Is the Purpose of This Form?
General Instructions
Form N-565, Application for Replacement Naturalization/
Step 1. Fill Out the Form N-565.
Citizenship Document, is used to apply to U.S. Citizenship
1. Type or print legibly in black ink.
and Immigration Services (USCIS) for a replacement of a:
1. Declaration of Intention;
2. If extra space is needed to complete any item, attach a
continuation sheet, write your name and Alien Registration
2. Certificate of Naturalization;
Number (A-Number) (if any), at the top of each sheet of
paper, indicate the Part and item number to which your
3. Certificate of Citizenship;
answer refers, and date and sign each sheet.
4. Repatriation Certificate; or
3. Answer all questions fully and accurately. State that an
5. To apply for a special certificate of naturalization as a U.S.
item is not applicable with "N/A." If the answer is none,
citizen to be recognized by a foreign country.
write "none."
NOTE: USCIS has no legal basis to change a name absent a
Step 2. Initial Evidence Requirements.
legal document such as a marriage certificate, divorce decree,
or a court ordered name change. In addition, USCIS is
1. If you are applying for replacement of a mutilated
prohibited from making any changes to an incorrect date of
document, you must attach the mutilated document.
birth if one has completed the naturalization/citizenship
process and sworn to the facts, including the wrong date of
2. If you are applying for a new document because your name
birth.
has been changed, you must submit the original USCIS
document and a copy of the marriage certificate or court
order showing the name change.
Who May File Form N-565?
3. If you are applying for a special certificate of
You may apply for a replacement:
naturalization, you must attach a copy of your
naturalization certificate.
1. If you have been issued a Certificate of Naturalization,
Certificate of Citizenship, Declaration of Intention or
Copies.
Unless specifically required that an original
Repatriation Certificate which has been lost, mutilated, or
document be filed with an application, a legible photocopy
destroyed;
may be submitted. Original documents submitted when not
2. If your name has been changed by marriage or by court
required may remain a part of the record, and will not be
order after the document was issued and you seek a
automatically returned to you.
document in the new name; or
3. If you are a naturalized citizen desiring to obtain
recognition as a citizen of the United States by a foreign
country, you may apply for a special certificate for that
purpose.
Form N-565 Instructions (Rev. 02/28/13) Y
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