This document is an application for a replacement naturalization or citizenship document from the U.S. Citizenship and Immigration Services (USCIS). It requests information about the applicant such as name, address, and date of birth. It asks the applicant to specify which type of replacement document they need such as a certificate of citizenship or naturalization. The applicant must provide details about their previous citizenship or naturalization document such as when and where it was issued. If the name has changed, documentation of the name change must be attached. The applicant signs the application certifying that the information provided is true and correct.
Original Description:
Replace Certificate of Citizenship
Individuals can submit Form N-565 to request a replacement of Naturalization Certificate or Certificate of Citizenship. The purpose of Form N-565 is to apply for a replacement of citizenship or naturalization document.
A Certificate of Naturalization is the official document issued by United States Citizenship and Immigration Service (USCIS) as proof of a person who has been granted U.S. citizenship through naturalization.
A Certificate of Citizenship is the official document issued by USCIS as proof of a person obtaining U.S. citizenship through U.S. citizen birth parents, regardless if the birth took place overseas. Or, if your parents became naturalized while you were under the age of 18 and met the special conditions of the law.
Individuals who are eligible to apply for replacement of Naturalization Certificate or Certificate of Citizenship using form N-565 are those who have been previously issued either one of these USCIS documents. If your Naturalization or Citizenship document has been lost, stolen or destroyed form N-565 is the application to file with USCIS. Or, if you need to have your name changed on your original document due to marriage or court order form N-565 would also be required.
This document is an application for a replacement naturalization or citizenship document from the U.S. Citizenship and Immigration Services (USCIS). It requests information about the applicant such as name, address, and date of birth. It asks the applicant to specify which type of replacement document they need such as a certificate of citizenship or naturalization. The applicant must provide details about their previous citizenship or naturalization document such as when and where it was issued. If the name has changed, documentation of the name change must be attached. The applicant signs the application certifying that the information provided is true and correct.
This document is an application for a replacement naturalization or citizenship document from the U.S. Citizenship and Immigration Services (USCIS). It requests information about the applicant such as name, address, and date of birth. It asks the applicant to specify which type of replacement document they need such as a certificate of citizenship or naturalization. The applicant must provide details about their previous citizenship or naturalization document such as when and where it was issued. If the name has changed, documentation of the name change must be attached. The applicant signs the application certifying that the information provided is true and correct.
Family Name Middle Name Address - In care of: Street Number and Name Apt. Number State or Province City or Town Country Zip or Postal Code Date of Birth (mm/dd/yyyy) Country of Birth Certificate Number A-Number Part 2. Type of application 1. I hereby apply for: (check one) New Certificate of Citizenship a. New Certificate of Naturalization b. New Certificate of Repatriation c. New Declaration of Intention d. Special Certificate of Naturalization to obtain recognition of my U.S. citizenship by a foreign country. (Skip Number 2 and go to Part 3) e. 2. Basis for application: (Refer to the instructions for additional information.) My certificate is/was lost, stolen or destroyed (attach a copy of the certificate if you have one). Explain when, where and how. a. My certificate is mutilated (attach the certificate). My name has been changed (attach the certificate). c. My certificate or declaration is incorrect (attach the document(s)). d. Part 3. Processing information Marital Status Widowed Height Single Male Gender Divorced Married Female My last certificate or Declaration of Intention was issued to me by: USCIS Office or Name of Court: Date (mm/dd/yyyy): Name in which the document was issued: Other names I have used (if none, so indicate): Since becoming a citizen, have you lost your citizenship in any manner? No Yes (attach an explanation) Part 4. Complete if applying for a new document because of a name change Name changed to present name by: (check one) Marriage or divorce on (mm/dd/yyyy) (Attach a copy of marriage or divorce certificate) Court Decree(mm/dd/yyyy) (Attach a copy of the court decree) Department of Homeland Security U.S. Citizenship and Immigration Services Form N-565, Application for Replacement Naturalization/Citizenship Document For USCIS Use Only Returned Receipt Resubmitted Reloc Sent Reloc Rec'd Applicant Action Block Fill in box if Form G-28 is attached to represent the applicant. VOLAG No. ATTY State License Number To Be Completed by Attorney or Representative, if any. Declaration of Intention verified by Citizenship verified by b. Remarks Interviewed Given Name FormN-565 (Rev. 02/28/13) Y Telephone Number (with area/country codes) E-Mail Address (if any) OMB No. 1615-0091; Expires 02/28/2015 If you are applying for a new certificate or Declaration of Intention because your current one is incorrect, explain why it is incorrect and attach copies of the documents supporting your request. Part 6. Complete if applying for a special certificate of recognition as a citizen of the U.S. by the government of a foreign country Name of Foreign Country Information about official of the country who has requested this certificate (if known) Name Government Agency: Address: Street Number and Name Suite Number City State/Province Zip or Postal Code Country Date (mm/dd/yyyy) Signature Date (mm/dd/yyyy) Signature of USCIS or Consular Official Part 8. Signature of person preparing form, if other than the applicant I declare that I prepared this application at the request of the applicant and it is based on all information of which I have knowledge. Print Your Name Signature Firm Name and Address Part 5. Complete if applying to correct your document Official Title Print Your Name NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be found eligible for a certificate and this application may be denied. FormN-565 (Rev. 02/28/13) Y Page 2 Date (mm/dd/yyyy) Part 7. Signature Read the information on penalties in the instructions before completing this part. If you are going to file this application at a USCIS office in the United States sign below. If you are going to file this application at a USCIS office abroad, sign it in front of a USCIS or Consular Official. I certify, or if outside the United States, I swear or affirm, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with it is all true and correct. I authorize the release of any information from my records which U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking. E-Mail Address (if any) Telephone Number (with area code)
Clifford Burr, by His Parents and Next Friends, Kenneth Burr, Betty Burr v. Thomas Sobol, As Commissioner of The New York State Education Department, 888 F.2d 258, 2d Cir. (1989)