Fill and Sign the Comments on Form N 565 Application for Replacement Reginfogov

Affidavit of Naturalized Citizen (Naturalization Papers Lost or Destroyed) 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 and says: 1. I reside at _________________________________________________ (address of affiant), ______________________ (name of city), ______________________ (name of county), ______________________ (name of state). 2. I am a naturalized citizen of the United States. 3. I entered the United States ________________________________________ (affiant's entry authorization, such as: on an immigrant visa) in the year ___________ (year), at _____________________ (port of entry). 4. I was admitted to United States citizenship by the United States District Court for the ________________________________________ (designation of district) of __________________ (name of state) in the year __________ (identification of year). 5. My certificate of naturalization is ____________________________________________ (lost/destroyed/beyond my present reach), and I do not have a certified copy of it. 6. I last saw my certificate of naturalization, or a certified copy, at ____________________ _____________________ (name of place) on or about _________________ (date). 7. My certificate was _______________________________________________________ ______________________________________________________________________ (state circumstances of loss, destruction, or unavailability of certificate). ________________________________(Signature of Affiant)________________________________ (Print or Type Name) SWORN to and subscribed before me, this the ______ day of _________________, 20______.
the bearer hereof affiant. Section iii. (1) (purchase of passport or replacement document) (a) a naturalized citizen of the United States who is a citizen of the state of residence of the naturalized citizen who desires to purchase or is issued a replacement document shall submit to the appropriate county clerk his or her application for the purchase of a citizen passport or a citizen replacement document, including the amount due, the name, address and other personal and public-interest information the naturalized citizen desires to be displayed on such certificate of naturalization issued by the appropriate county clerk, and a completed application form, as prescribed by the appropriate county clerk. A noncitizen who possesses a passport issued by a foreign state shall submit to the appropriate county clerk his or her application for issuance of a citizen passport or a citizen replacement document. (b) if a citizen passport or citizen replacement document is requested by a noncitizen who possesses a United States passport, the united states consular officer at the port of entry shall, upon receiving the application, forward proof of identity to the appropriate county clerk within 10 days (10 days for an application for a citizen passport). (c) if a noncitizen who possesses a United States passport requests a citizen passport or citizen replacement document, the passport issuer shall forward to the appropriate county clerk proof of identity within 10 days (10 days for an application for a citizen passport). If the passport has not yet been issued to the citizen or noncitizen, the application for the issuance or replacement must be made within 10 days (10 days for an application for a citizen passport). If the passport is issued to the citizen or noncitizen in its current form, the passport issuer shall, within 30 days (30 days for an application for a citizen passport) notify the appropriate county clerk of the application. If the passport is issued in its original or corrected form in its current or corrected state, the passport issuer may notify the appropriate county clerk of the application. (d) if, after a delay under paragraph (b) or subparagraph (3)(d) of this paragraph, the holder of a United States passport or a citizen replacement document is notified of the application or issuance of the passport or replacement document by the appropriate county clerk, the applicable fee, if any, payable to the United States department of state, will not be assessed until after the expiration of 10 days. (3) (a) if a citizen is not entitled