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N-644, Application for Posthumous Citizenship (United States)

This form is to apply for posthumous citizenship of the United States. The form provided here is simply a sample of what the actual Form N-644 looks like.

Department of Homeland Security
U.S Citizenship and Immigration Services

N-644, Application for Posthumous Citizenship

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Fee Stamp


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PART I - To Be Completed by the Applicant

A. Information about you, the Applicant

1. Name (Last/First/Middle) ________________________________

2. Address (Street Name and Number________________________________

________________________________ (Town/City, State/Country, ZIP/Postal Code)

3. If abroad, city/country of nearest American Embassy or Consulate ________________________________

4. Telephone number (include Area Code) ________________________________

5. Total Number of Authorization Affidavits Attached (see instructions) ________________________________

6. Your Relationship to Decedent at time of his/her death (check one)

Next-of-Kin

a. ____ Spouse
b. ____ Parent
c. ____ Son/Daughter
d. ____ Brother/Sister

Representative

e. ____ Executor or Administrator of Decedent's Estate
f. ____ Guardian, Conservator, or Committee of Decedent's Next-of-Kin
g. ____ VA Recognized Service Organization (Name below)
________________________________ (Name of Service Organization)

B. Information about the Decedent

1. Name Used During Active Service (Last/First/Middle) ________________________________

2. Other Names Used ________________________________

3. Date of Birth (MM/DD/YYYY) ________________________________

4. Place of Birth (City/State/Country) ________________________________

5. Date of Death (MM/DD/YYYY) ________________________________

6. Place of Death (City/State/Country) ________________________________

7. Immigration Status at Time of Death (Permanent Resident, Student, Visitor, etc.) ________________________________

8. Alien Registration Number or Other INS File Number ________________________________

9. Social Security Number (if any) ________________________________

10. Father's Full Name ________________________________

a. ____ Living
b. ____ Deceased

11. Mother's Maiden Name ________________________________

a. ____ Living
b. ____ Deceased

12. Marital Status at Time of death

a. ____ Married
b. ____ Widowed
c. ____ Divorced
d. ____ Single

13. Military Service Serial Number (If different from Social Security #) ________________________________

14. Date Entered Active Duty Service (MM/DD/YYYY) ________________________________

15. Place Entered Active Duty Service (City/State/Country) ________________________________

16. Date Released From Active Duty Service (MM/DD/YYYY) ________________________________

17. Branch of Service ________________________________

18. Type of Discharge ________________________________

19. Military Rank at Time of Discharge ________________________________

20. Retired From military? ____ Yes ____ No

21. VA Claim Number (if any) ________________________________

22. Total Number of Children (if none, write None) ________________________________

23. Complete the Following for Each Child.

Name (Last/First/Middle) ________________________________

Date of Birth (MM/DD/YYYY) ________________________________

____ Lliving ____ Deceased

24. Total Number of Brothers and Sisters (if none, write None) ________________________________

25. Complete the Following for Each Brother and Sister.

Name (Last/First/Middle) ________________________________

Date of Birth (MM/DD/YYYY) ________________________________

Certification of Applicant

I certify, under penalty of perjury under the laws of the United States of America, that the information in Part I is true and correct.

Signature ________________________________

Date ________________________________

Declaration of person preparing form, if other than above.

I declare that I prepared this document at the request of the person above and that it is based on all information of which I have any knowledge.

Signature ________________________________

Date ________________________________

Name (print or type) ________________________________

Address ________________________________

PART II - To Be Completed by the Applicable Executive Department

1. ____ No Active Duty Records Found for This Individual
2. ____ No Casualty Records Found for This Individual
3. ____ Name of Decedent Correctly Shown
4. ____ Name of Decedent Different in Records ________________________________ (List name shown in records)

5. ____ Active Duty Service Records Found

(complete a through f)

a. Branch of Service ________________________________

b. Date Entered Active Duty ________________________________

c. Place Entered Active Duty Service (City/State/Country)
________________________________

d. Service Number ________________________________

e. Date Released From Service (MM/DD/YYYY) ________________________________

f. Honorable Service During a Period of Hostilities by ________________________________

____ Yes ____ No

6. Individual Entered Service Under the Lodge Act?

____ Yes ____ No ____ Unable to Determine

7. ____ Record of Death Found

(Complete a and b)

a. Date of Death ________________________________

b. Death resulted from injury or disease incurred in or aggravated by active duty service during a period of military hostilities specified by law?

____ Yes ____ No ____Unable to Determine

8. Certification

I certify the information given here concerning the

(check one or both, as appropriate)

____ Service ____ Death

of the individual named on this form is correct according to the records of the (Name below) (Specify Executive Department)

Signature ________________________________

Date ________________________________

Title ________________________________

PART III - To Be Completed by the Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports

A. Certification

Based on the information received from the Department of Veterans Affairs concerning the death of the individual named on this form, I certify that the individual died on

Date (MM/DD/YYYY) ________________________________

________________________________ as a result of injury or disease incurred in or Signature Date aggravated by service during a period of hostilities specified by law.

Signature ________________________________

Date ________________________________

Title ________________________________

B. Unable to Certify

Based on the information received from the Department of Veterans Affairs concerning the death of the individual named on this form, I am unable to certify that the individual died as a result of injury or disease incurred in or aggravated by service during a period of hostilities specified by law.

Signature ________________________________

Date ________________________________

Title ________________________________

Part IV - To Be Completed by Bureau of Citizenship and Immigration Services

Space below (Part IV) for use of the Bureau of Citizenship and Immigration Services ONLY

Action Stamp

Applicant Authorized Next-of-Kin or Representative

Positive Certification Military Service

Positive Certification Service Connected Death

Place of Enlistment Qualifies Under INA Section 329(a)(1)

Decedent Admitted for Lawful Permanent Residence

Cert. # ________________________________

Date Mailed ________________________________

A # ________________________________

Reg. Mail # ________________________________

Initial Receipt ____________

Relocated ____________

Resubmitted: Rec'd Sent ____________

Completed: App'd ____________

Denied ____________

Ret'd ____________

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