Form N-426 Request For Certification Of Military Or Naval Service - Department Of Homeland Security

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OMB No. 1615-0053 ; Expires 04/30/2015
N-426, Request for Certification
Department of Homeland Security
of Military or Naval Service
U.S. Citizenship and Immigration Services
For USCIS Use Only
Persons who are serving or have served under specified conditions in the Armed Forces of the United States are granted certain exemptions
from the general requirements for naturalization. To establish eligibility, the law requires the department with custody of the service record
Date Returned:
to certify whether the service member served honorably, and whether each separation from the service was under honorable conditions.
To:
Certification of the service member's military service listed on this form is required. Submit this form with Form N-400, Application for
Initials:
Naturalization. For further assistance, contact the Military Help Line, 1-877-CIS-4MIL (1-877-247-4645) or visit
Comments:
military.
Alien Registration Number
Date of Request
Military Service Number
A
Name Used During Military Service (Last, First, Middle)
U.S. Social Security Number
Date of Birth
Place of Birth (Country and City)
Present Address:
Phone Number(s):
E-Mail Address(es):
Military Service
List all periods of service. (attach an additional sheet(s) if you need to provide more information.)
TO BE COMPLETED BY
TO BE COMPLETED BY
CERTIFYING OFFICIAL
APPLICANT OR CERTIFYING OFFICIAL
Type of Service (includes all active, reserve,
Applicant served honorably or
Date Service Began
Branch of Service
Date Service Ended
and National Guard Service)
is currently serving honorably?
Active Duty
Yes
No (give details in Remarks)
Selected Reserve of the Ready Reserve*
Active Duty
Yes
No (give details in Remarks)
Selected Reserve of the Ready Reserve*
Active Duty
Yes
No (give details in Remarks)
Selected Reserve of the Ready Reserve*
*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 each 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)
Where did the applicant enlist (Country, State, and City where the applicant entered service)?
Where did the applicant reenlist?
Has the applicant reenlisted?
Yes
No
Signature of Applicant
Separation Information
Yes
No
Is the applicant separated
?
If separated, select discharge type:
Honorable
Other (give details in Remarks section)
Yes
Was the applicant discharged on account of alienage?
No (if "Yes," give details in Remarks section)
Remarks
Use for continuation of any of the above items. You should also list in the space below any derogatory information in your records relating to the service
member's character, loyalty to the United States, disciplinary actions, convictions, or other matters concerning his or her fitness for citizenship. (Use a blank sheet
if more space is needed.)
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 form is correct according to the records of the
Official Signature
Name of Department
Name and Title
[SEAL, if available]
(No State-issued notary
Phone Number and E-Mail Address
Date _______________, ______________
Public seals accepted.)
Form N-426 (Rev. 04/30/13)Y

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