Form N-400 - Application For Naturalization Page 10
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10Write your USCIS A-Number here:
Part 11. Your Signature
A
I certify, under penalty of perjury under the laws of the United States of America, that this application, and the evidence submitted with
it, are all true and correct. I authorize the release of any information that the USCIS needs to determine my eligibility for naturalization.
Date (mm/dd/yyyy)
Your Signature
Part 12. Signature of Person Who Prepared This Application for You
(If applicable)
I declare under penalty of perjury that I prepared this application at the request of the above person. The answers provided are based on
information of which I have personal knowledge and/or were provided to me by the above named person in response to the exact
questions contained on this form.
Preparer's Printed Name
Preparer's Signature
Date (mm/dd/yyyy)
Preparer's Firm or Organization Name (If applicable)
Preparer's Daytime Phone Number
Preparer's Address - Street Number and Name
City
State
Zip Code
NOTE: Do not complete Parts 13 and 14 until a USCIS Officer instructs you to do so.
Part 13. 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
application for naturalization subscribed by me, including corrections numbered 1 through
and the evidence submitted by me
numbered pages 1 through
, are true and correct to the best of my knowledge and belief.
Subscribed to and sworn to (affirmed) before me
Officer's Printed Name or Stamp
Date (mm/dd/yyyy)
Complete Signature of Applicant
Officer's Signature
Part 14. Oath of Allegiance
If your application is approved, you will be scheduled for a public oath ceremony at which time you will be required to take the following
Oath of Allegiance immediately prior to becoming a naturalized citizen. By signing, you acknowledge your willingness and ability to take
this oath:
I hereby declare, on oath, that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince, potentate,
state, or sovereignty, of whom or which I have heretofore been a subject or citizen;
that I will support and defend the Constitution and laws of the United States of America against all enemies, foreign and domestic;
that I will bear true faith and allegiance to the same;
that I will bear arms on behalf of the United States when required by the law;
that I will perform noncombatant service in the Armed Forces of the United States when required by the law;
that I will perform work of national importance under civilian direction when required by the law; and
that I take this obligation freely, without any mental reservation or purpose of evasion, so help me God.
Complete Signature of Applicant
Printed Name of Applicant
Form N-400 (Rev. 06/17/11) Y Page 10
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