Fill and Sign the Citizenship Proving Form

Affidavit of Naturalized Citizen to be used when Proving Naturalization State of __________________________ County of ________________________ PERSONALLY appeared before me, the undersigned authority in and for said county and state, _______________________ (Name of Affiant) who, having been being first duty sworn by the undersigned Notary Public, deposes I, ______________________ (Name of Affiant) , being first duly sworn, depose and say: 1. I am a resident of _________________ (name of city) , _________________ (name of county) , ____________________ (name of state) . 2. I was born on __________________ (date of birth) , in ____________________ (name of city) , ______________________ (name of foreign country) . 3. I immigrated to the United States on _______________________ (date of emigration) . 4. I am a naturalized citizen of the United States. 5. I was naturalized and received my certificate of naturalization from the __________ _____________________________________ (name of naturalizing court) in the year ________________ (year of naturalization) . 6. My certificate of naturalization has never been revoked or canceled. ________________________________ (Signature of Affiant) ________________________________ (Print or Type Name) SWORN to and subscribed before me, this the ______ day of ________________, 20______. __________________________ NOTARY PUBLIC My Commission Expires: _________________________