Form N-400 - Application For Naturalization - U.s. Citizenship And Immigration Services Page 19
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20A-
Part 15. Contact Information, Declaration, and Signature of the Person
Preparing This Application, if Other Than the Applicant (continued)
Preparer's Contact Information
4.
Preparer's Daytime Telephone Number
5.
Preparer's Mobile Telephone Number (if any)
6.
Preparer's Email Address (if any)
Preparer's Statement
7.
A.
I am not an attorney or accredited representative but have prepared this application on behalf of
the applicant and with the applicant's consent.
B.
I am an attorney or accredited representative and my representation of the applicant in this case
extends
does not extend beyond the preparation of this application.
NOTE: If you are an attorney or accredited representative whose representation extends beyond
preparation of this application, you may be obliged to submit a completed Form G-28, Notice of
Entry of Appearance as Attorney or Accredited Representative, with this application.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then
reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted
with, his or her application, including the Applicant's Certification, and that all of this information is complete, true, and correct. I
completed this application based only on information that the applicant provided to me or authorized me to obtain or use.
Preparer's Signature
Preparer's Signature
8.
Date of Signature (mm/dd/yyyy)
NOTE: Do not complete Parts 16., 17., or 18. until the USCIS Officer instructs you to do so at the
interview.
Part 16. Signature at Interview
I swear (affirm) and certify under penalty of perjury under the laws of the United States of America that I know that the contents of
this Form N-400, Application for Naturalization, subscribed by me, including corrections number 1 through ____________, are
complete, true, and correct. The evidence submitted by me on numbered pages 1 through ________________ are complete, true, and
correct.
Subscribed to and sworn to (affirmed) before me
USCIS Officer's Printed Name or Stamp
Date of Signature (mm/dd/yyyy)
Applicant's Signature
USCIS Officer's Signature
Form N-400 12/23/16 N
Page 19 of 20
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