Read the information on penalties in the instructions before completing this part. If you are going to file this mmddyyyy form n565 rev. Physicians drug enforcement administration registration number or comparable foreign registration number if applicable. Language stating you have a doctorpatient relationship with the certifying. However, all filings postmarked 122316 or later must include the new fees or we will reject them. Instructions for form n565, application for department of. Start here please type or print in black inkpart 1. Complete form n565 application for replacement naturalizationcitizenship document. If you are going to file this application at a uscis office abroad, sign it in front of a uscis or consular official. If you have been issued a naturalization certificate. The check or money order must be drawn on a bank or other financial institution located in the united states and must be payable in u. If you need extra space to complete any item within this application, use the space provided in part. Telephone number with areacountry codes email address if any 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.
Instructions for form n565, application for replacement. Form n565, application for replacement naturalizationcitizenship. Get the forn n 565 aplication family name form pdffiller. However, because uscis fees change periodically, you can verify if the fees are correct by following one of the steps below.
The government of a foreign country name of foreign country information about official of the country who has requested this certificate if known official title name of government agency address of foreign official uscis or consular official s certification date of signature part 9. You can find the edition date at the bottom of the page on the form and instructions. If you pay by check, you must make your check payable to the u. Read the penalties section of the form n 565 instructions before completing this part. If you file your form n 565 by mail paper, you may pay the fee with a money order, personal check, cashiers check, or by credit card using form g1450, authorization for credit card transactions. Applicants statement, contact information, certification, and signature note. If your name was changed after a certificate of citizenship was granted to you, you may file form n565, to obtain a new document in the new name. If you were born in the united states, you do not need to apply to uscis for any evidence. Applicant s statement contact information certification and.
Download form n 565 replace citizenship certificate or certificate of naturalization. Application for replacement naturalizationcitizenship document author. A special certificate of naturalization will be required by the individual to prove that he is a us citizen, to a. Download the form from the uscis website or call the tollfree forms. Form n565, application for replacement naturalization. Additional information or attach a separate sheet of paper.
Starting 022117, uscis will only accept the 122316 edition. Language stating that the individual has had appropriate clinical treatment for gender transition to the new gender male or female. An individual may also use this form to apply for a special certificate of naturalization. Instructions for n565, application for replacement. Fill forn n 565 aplication family name, download blank or editable online. Use this form to apply for a replacement declaration of intention. If there are mistakes on your citizenship certificate, you must not file this form to correct those errors. Form n565 application for replacement naturalization. Besides, you may file form n565, if you need a special certificate of naturalization. Instructions for n565, application for department of. By continuing to use this site you consent to the use of cookies on your device as described in our cookie policy unless you have disabled them. Application for replacement naturalizationcitizenship. If you file your form n 565 online, you may pay your fee online.
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