Form N-600k - Application For Citizenship And Issuance Of Certificate Under Section 322 Page 6
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13A-
Part 4. Information About the Child's Qualifying U.S. Citizen Grandparent
(continued)
8.
Evening Telephone Number
9.
Mobile Telephone Number (if any)
10.
Email Address (if any)
11.
The grandparent is a U.S. citizen by:
Birth in the United States
Acquisition after birth through naturalization of alien parents
Birth abroad to U.S. citizen parents
Certificate of Citizenship Number
A-Number (if known)
►
A-
Naturalization
Place of Naturalization
Name of Court or USCIS Office Location
City or Town
State
Certificate of Naturalization Number
A-Number (if known)
Date of Naturalization (mm/dd/yyyy)
►
A-
12.
Has the grandparent ever lost U.S. citizenship or taken any action that would cause loss of U.S. citizenship?
Yes
No
If the answer is “Yes” to Item Number 12., provide a full explanation in the space provided in Part 11.
Additional Information.
Part 5. Physical Presence in the United States From Birth Until Filing of Form N-600K
NOTE: Provide the dates that the U.S. citizen parent or grandparent was present in the United States. If the U.S. citizen parent has
not been physically present in the United States for five years, two years of which were after 14 years of age, then the child must use
the physical presence of the U.S. citizen grandparent.
1.
Indicate whether this information relates to the U.S. citizen parent or to the qualifying grandparent.
U.S. Citizen Parent
U.S. Citizen Grandparent
2.
Physical Presence in the United States
A. From (mm/dd/yyyy)
Until (mm/dd/yyyy)
B. From (mm/dd/yyyy)
Until (mm/dd/yyyy)
C. From (mm/dd/yyyy)
Until (mm/dd/yyyy)
D. From (mm/dd/yyyy)
Until (mm/dd/yyyy)
E. From (mm/dd/yyyy)
Until (mm/dd/yyyy)
F. From (mm/dd/yyyy)
Until (mm/dd/yyyy)
G. From (mm/dd/yyyy)
Until (mm/dd/yyyy)
H. From (mm/dd/yyyy)
Until (mm/dd/yyyy)
NOTE: If the U.S. citizen biological/adoptive parent is filing this application, skip Part 6. and go directly to Part 7.
Form N-600K 02/13/17 N
Page 6 of 13
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