Form N-426 - Request For Certification Of Military Or Naval Service Page 2
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4Part 3. Periods of Military Service (To be completed by requestor)
Provide all periods of service. If you need extra space to complete this section, use the space provided in Part 9. Additional
Information.
Date Service
Date Service
Type of Service (include all active, reserve,
Military Service
Branch of Service
Began
Ended
and National Guard Service)
(mm/dd/yyyy)
(mm/dd/yyyy)
Active Duty
Military Service 1
Selected Reserve of the Ready Reserve*
Active Duty
Military Service 2
Selected Reserve of the Ready Reserve*
Active Duty
Military Service 3
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 a 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)
Part 4. Requestor's Contact Information, Certification, and Signature
Requestor's Contact Information
1.
Requestor's Daytime Telephone Number
2.
Requestor's Mobile Telephone Number (if any)
3. Requestor's Email Address (if any)
Requestor's Certification
I authorize release of information contained in this request, in supporting documents, and in my USCIS records to other entities and
persons where necessary for the administration and enforcement of U.S. immigration laws.
I certify, under penalty of perjury, that all of the information in my request and any document submitted with it were provided by me
and are complete, true, and correct.
Requestor's Signature
4.
Requestor's Signature
Date of Signature (mm/dd/yyyy)
NOTE TO ALL REQUESTORS: USCIS may deny your request if you do not completely fill out this request or fail to submit
required documents listed in the Instructions.
Part 5. Character of Service (To be completed by Certifying Official)
State whether the requestor served honorably or is currently serving honorably for each period of military service the requestor served
(refer to Part 3. Periods of Military Service). If you answer “No,” provide details in Part 7. Remarks.
1.
Honorable Period of Military Service 1
Yes
No
2.
Honorable Period of Military Service 2
Yes
No
3.
Honorable Period of Military Service 3
Yes
No
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Form N-426 07/25/17 N
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