Form N-4 - Monthly Report Naturalization Papers

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OMB NO. 1615-0051; Expires 08/31/2019
N-4, Monthly Report
Department of Homeland Security
on Naturalization Papers
U.S. Citizenship and Immigration Services
Date:
Office of the Clerk of the
Court
(County or District)
(City, State, and Zip Code)
U.S. Citizenship and Immigration Services:
In compliance with the naturalization laws and regulations, listed below are each oath administration ceremony conducted under the
jurisdiction of the above named court during the month and
year.
I have also enclosed the duplicate court list endorsed by me as clerk of the above named court during the same month, except for those
that have already been delivered personally to your representative. Those so delivered are indicated by an (*) next to the court list
number.
Also enclosed are (
) voided Certificates of Naturalization. A specific listing of the voided certificates may be found on
each endorsed court list.
(Clerk of Court)
By
(Deputy Clerk)
Date of
Number of Persons
Number of
Court List Number
Place of Ceremony
Ceremony
Administered Oath
Voided Certificates
Form N-4 08/01/17 Y
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