N 644

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N 644

  1. 1. OMB No. 1615-0059; Expires 10/31/2011 N-644, Application forDepartment of Homeland SecurityU.S. Citizenship and Immigration Services Posthumous Citizenship For USCIS Only Fee StampPart 1. Information About the Applicant (To be completed by the applicant only)1. Name (Last/First/Middle) 8. Your Relationship to Decedent at Time of His/Her Death (Check one) Next-of-Kin2. Address (Street Name and Number) a. Spouse b. Parent(Town/City, State/Country, Zip/Postal Code) c. Son/Daughter d. Brother/Sister3. If Abroad, City/Country of Nearest U.S. Embassy or Consulate Representative e. Executor or Administrator of Decedents Estate4. Date of Birth 5. A-Number, if applicable Guardian, Conservator, or Committee of Decedents f. Next-of-Kin g. VA Recognized Service Organization (Name below)6. Total Number of Authorization Affidavits Attached (See instructions) (Name of Service Organization)7. Telephone Number (Include Area/Country Code) 9. E-mail Address( )B. Information About the Decedent1. Name Used During Active Service (Last/First/Middle) 7. Immigration Status at Time of Death (Permanent Resident, Student, Visitor, etc.)2. Other Names Used3. Date of Birth (mm/dd/yyyy) 5. Place of Birth (City/State/Country) 8. A-Number or Other USCIS File Number4. Date of Death (mm/dd/yyyy) 6. Place of Death (City/State/Country) 9. U.S. Social Security Number (If any) Form N-644 (Rev. 10/06/10) Y
  2. 2. B. Information About the Decedent (Continued)10. Fathers Full Name Living B. Living Deceased Deceased Name (Last/First/Middle) Date of Birth (mm/dd/yyyy)11. Mothers Maiden Name Living Deceased C. Living Deceased Name (Last/First/Middle) Date of Birth (mm/dd/yyyy)12. Marital Status at Time of Death a. Married c. Widowed D. Living Deceased b. Divorced d. Single Name (Last/First/Middle) Date of Birth (mm/dd/yyyy)13. Military Service Serial Number (If different from Social Security #) E. Living Deceased14. Date Entered Active Duty Service (mm/dd/yyyy) Date of Birth (mm/dd/yyyy) Name (Last/First/Middle)15. Place Entered Active Duty Service (City/State/Country) 24. Total Number of Brothers and Sisters (If none, write "None")16. Date Released From Active Duty Service (mm/dd/yyyy) 25. Complete the Following for Each Brother and Sister17. Branch of Service 18. Type of Discharge A. Living Deceased Name (Last/First/Middle) Date of Birth (mm/dd/yyyy)19. Military Rank at Time of 20. Retired From Military?Discharge Yes No B. Living Deceased21. VA Claim Number (If any) Name (Last/First/Middle) Date of Birth (mm/dd/yyyy)22. Total Number of Children (If none, write "None") C. Living Deceased Name (Last/First/Middle) Date of Birth (mm/dd/yyyy)23. Complete the Following for Each ChildA. Living Deceased D. Living Deceased Name (Last/First/Middle) Date of Birth (mm/dd/yyyy) Name (Last/First/Middle) Date of Birth (mm/dd/yyyy) Form N-644 (Rev. 10/06/10) Y Page 2
  3. 3. B. Information About the Decedent (Continued) Certificate of ApplicantE. Living Deceased I certify, under penalty of perjury under the laws of the United States Name (Last/First/Middle) Date of Birth (mm/dd/yyyy) of America, that the information in Part I is true and correct. Signature DateF. Living Deceased Name (Last/First/Middle) Date of Birth (mm/dd/yyyy) Name (Print or Type) Address (Street Number and Name, City/Town, State/Province,G. Living Deceased Country, Zip-Postal Code Name (Last/First/Middle) Date of Birth (mm/dd/yyyy)Part II. To Be Completed by the Applicable Executive Department1. No Active Duty Records Found for This Individual 6. Individual Entered Service Under the Lodge Act?2. No Casualty Records Found for This Individual Yes No Unable to Determine3. Name of Decedent Correctly Shown 7. Record of Death Found (Complete a and b)4. Name of Decedent Different in Records a. Date of Death (mm/dd/yyyy) (List name shown in records) b. Death resulted from injury or disease incurred in or Active Duty Service Records Found aggravated by active duty service during a period of5. (Complete a through f) military hostilities specified by law? Yes No Unable to Determine a. Branch of Service 8. Certification I certify the information given here concerning the b. Date Entered Active Duty (Check one or both, as appropriate) Service Death c. Place Entered Active Duty Service (City/State/Country) of the individual named on this form is correct according to the records of the (name below). d. Service Number (Specify Executive Department) e. Date Released From Service (mm/dd/yyyy) Signature Date f. Honorable Service During a Period of Hostilities Title Phone number (If no is checked, please provide an explanation) Yes No E-mail address Form N-644 (Rev. 10/06/10) Y Page 3
  4. 4. Part III. To Be Completed by the Department of Defense, Washington Headquarters Services, Directorate for Information Operations and ReportsA. Certification B. Unable to Certify Based on the information received from the Department Based on the information received from the Department of Veterans Affairs concerning the death of the of Veterans Affairs concerning the death of the individual named on this form, I certify that the individual named on this form, I am unable to certify that the individual died as a result of injury or disease individual died on: incurred in or aggravated by service during a period of Date (mm/dd/yyyy) hostilities specified by law. as a result of injury or disease incurred in or aggravated Signature Date by service during a period of hostilities specified by law.Signature Date TitleTitle NOTE: Space below (Part IV) for use by U.S. Citizenship and Immigration Services OnlyPart IV. To be Completed by U.S. Citizenship and Immigration Services Applicant Authorized Next-of-Kin or Representative Action Block 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 MailedA# Reg. Mail # Initial Receipt Resubmitted Relocated Completed Recd Sent Appd Denied Retd Form N-644 (Rev. 10/06/10) Y Page 4

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