Immigration Citizenship Application

Immigration Citizenship Application

This Immigration Citizenship Application (the "Application") is submitted on this date: by Applicant Name: (Applicant) to Receiving Authority Name: (Receiving Authority) for consideration of naturalization or conferral of citizenship as set forth below.

RECITALS

WHEREAS, Applicant seeks to obtain citizenship status under applicable immigration laws and regulations and submits this Application to document eligibility, submit supporting evidence, and consent to required administrative processing; and

WHEREAS, Receiving Authority is authorized to receive and process applications, verify identity and eligibility, obtain records and conduct background checks as necessary to determine fitness for citizenship; and

WHEREAS, the parties desire that Applicant provide the representations, declarations, and supporting information set forth in this Application and consent to the terms and certifications herein.

NOW THEREFORE, Applicant submits this Application and declares as follows.

1. APPLICANT INFORMATION

2. BASIS FOR APPLICATION

Applicant asserts one or more bases for eligibility. Check all applicable boxes and provide documentary proof.

Naturalization after lawful permanent residence and meeting residency requirements

Derivative citizenship claim through parentage or other statutory basis

Service in the uniformed services or other governmental service basis

3. ELIGIBILITY DECLARATIONS

Applicant hereby declares under penalty of perjury that the following statements are true and accurate to the best of Applicant's knowledge.

Continuous residence in the jurisdiction claimed: . Applicant attests to compliance with residence and physical presence requirements.

Applicant is able to read, write, and speak the English language to the extent required and possesses knowledge of the fundamentals of the history and government of the country as required by law: Attest.

4. CRIMINAL HISTORY / GOOD MORAL CHARACTER

Applicant must disclose any arrests, charges, convictions, or pending criminal proceedings in any jurisdiction.

Arrested, charged, or convicted of a crime: Yes    No

Applicant affirms that Applicant has not engaged in conduct that would render Applicant inadmissible or removable under applicable law, except as disclosed above. Applicant authorizes verification of criminal and immigration records where permitted by law.

5. SUPPORTING DOCUMENTS

Applicant submits the following supporting documents. Check those submitted with this Application and attach certified translations if applicable.

Birth certificate or other evidence of birth

Passport or travel document

Proof of lawful permanent residence

Marriage certificate (if applicable)

Police certificates or court records

6. FEES AND PAYMENT

Applicant acknowledges payment of the required application fee or claims an exemption where permitted. Provide amount and method below.

7. OATH, CERTIFICATION, AND CONSENTS

By signing this Application, Applicant certifies under penalty of perjury that all statements made in this Application and in the supporting documents are true and complete. Applicant understands that knowingly making a false statement or intentionally omitting material facts may subject Applicant to penalties, including denial of citizenship, fines, or criminal prosecution.

Applicant expressly authorizes Receiving Authority to obtain and verify records, including but not limited to immigration, criminal, tax, and employment records, and to request information from governmental and private entities necessary to adjudicate this Application.

8. NOTICES

Any notice or correspondence required under this Application shall be sent to Applicant at the current residence address provided above or to the mailing address below. Notices sent by certified mail or delivered to the addresses provided shall be effective upon mailing or delivery.

9. AMENDMENTS, WAIVER, AND MISCELLANEOUS

This Application may be amended by Applicant in writing prior to final adjudication. No waiver of any provision of this Application or of any right or remedy hereunder shall be effective unless in writing and signed by the party granting such waiver, and no waiver shall operate as a waiver of any other provision or subsequent breach.

10. GOVERNING LAW

This Application and any determinations made in connection with it shall be governed by and construed in accordance with the immigration and administrative laws and regulations applicable within the jurisdiction of Receiving Authority, without regard to conflict of law principles.

11. ENTIRE AGREEMENT

This Application, together with all attachments and declarations submitted in support, constitutes the entire record of Applicant's request for citizenship and supersedes any prior oral or written statements made in connection with this matter.

12. SEVERABILITY

If any provision of this Application is held to be invalid, illegal, or unenforceable by a court or tribunal of competent jurisdiction, the remaining provisions shall continue in full force and effect and shall be construed so as to give effect to the intent of the parties insofar as permitted by law.

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