Part 11. Information About Your Children (continued)
A-
Current Address
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
County
State
ZIP Code + 4
-
Province or Region
Postal Code
Country
(foreign address only)
(foreign address only)
(foreign address only)
What is your child's relationship to you? (for example, biological child,
stepchild, legally adopted child)
D. Child 4
Current Legal Name
Family Name (Last Name)
Given Name (First Name)
Middle Name (if applicable)
A-Number (if any)
Date of Birth (mm/dd/yyyy)
Country of Birth
►
A-
Current Address
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
County
State
ZIP Code + 4
-
Province or Region
Postal Code
Country
(foreign address only)
(foreign address only)
(foreign address only)
What is your child's relationship to you? (for example, biological child,
stepchild, legally adopted child)
Part 12. Additional Information About You (Person Applying for Naturalization)
Answer Item Numbers 1. - 21. If you answer "Yes" to any of these questions, include a typed or printed explanation on additional
sheets of paper.
1.
Have you EVER claimed to be a U.S. citizen (in writing or any other way)?
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.
A.
Do you now have, or did you EVER have, a hereditary title or an order of nobility in any foreign
Yes
No
country?
B.
If you answered "Yes," are you willing to give up any inherited titles or orders of nobility that you
Yes
No
have in a foreign country at your naturalization ceremony?
5.
Have you EVER been declared legally incompetent or been confined to a mental institution?
Yes
No
Form N-400 12/23/16 N
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