Form N-426 Request for Certification of Military or Naval Service

Persons who are serving or have served under specified conditions in the Armed Forces of the United States are granted certain exemptions
from the general requirements for naturalization. To establish eligibility, the law requires the department with custody of the service record
to certify whether the service member served honorably, and whether each separation from the service was under honorable conditions.
Certification of the service member's military service listed on this form is required. Submit this form with Form N-400, Application for
Naturalization. For further assistance, contact the Military Help Line, 1-877-CIS-4MIL (1-877-247-4645) or visit www.uscis.gov/
military.

Name Used During Military Service (Last, First, Middle)

Date of Birth

For USCIS Use Only
Date Returned:
To:
Initials:
Comments:

Place of Birth (Country and City)

Military Service
List all periods of service. (attach an additional sheet(s) if you need to provide more information.)
TO BE COMPLETED BY
CERTIFYING OFFICIAL

TO BE COMPLETED BY
APPLICANT OR CERTIFYING OFFICIAL

Active Duty
Active Duty

Active Duty

Yes

Yes

No (give details in Remarks)

Yes

No (give details in Remarks)

Yes

No (give details in Remarks)

No

Is the applicant separated?

Yes

No

If separated, select discharge type:

Honorable

Other (give details in Remarks section)

Yes

No (if "Yes," give details in Remarks section)

Certification
TO BE COMPLETED BY CERTIFYING OFFICIAL

Official Signature
[SEAL, if available]
(No State-issued notary
Public seals accepted.)

Name and Title
Date _______________, ______________

Phone Number and E-Mail Address
Form N-426 (Rev. 08/01/11)Y