New York N 400 Gahutu Add

Application for Naturalization USCIS
Form N-400
Department of Homeland Security OMB No. 1615-0052
U.S. Citizenship and Immigration Services Expires 09/30/2022
Date Stamp Receipt Action Block

For
USCIS
Use
Only
Remarks
► START HERE - Type or print in black ink. Type or print "N/A" if an item is not applicable or the answer is none, unless
otherwise indicated. Failure to answer all of the questions may delay U.S. Citizenship and Immigration Services (USCIS) processing
your Form N-400. NOTE: You must complete Parts 1. - 15.
If your biological or legal adoptive mother or father is a U.S. citizen by birth, or was naturalized before you reached your 18th
birthday, you may already be a U.S. citizen. Before you consider filing this application, please visit the USCIS Website at
www.uscis.gov for more information on this topic and to review the instructions for Form N-600, Application for Certificate of
Citizenship, and Form N-600K, Application for Citizenship and Issuance of Certificate Under Section 322.
NOTE: Are either of your parents a United States citizen? If you answer “Yes,” then complete Part 6. Information About Your
Parents as part of this application. If you answer “No,” then skip Part 6. and go to Part 7. Biographic Information.
Part 1. Information About Your Eligibility (Select only one box or your Enter Your 9 Digit A-Number:
Form N-400 may be delayed) ► A- 2 1 2 6 7 2 1 8 6
1. You are at least 18 years of age and:

A. Have been a lawful permanent resident of the United States for at least 5 years.
B. Have been a lawful permanent resident of the United States for at least 3 years. In addition, you have been married to
and living with the same U.S. citizen spouse for the last 3 years, and your spouse has been a U.S. citizen for the last
3 years at the time you filed your Form N-400.
C. Are a lawful permanent resident of the United States and you are the spouse of a U.S. citizen and your U.S. citizen
spouse is regularly engaged in specified employment abroad. (See the Immigration and Nationality Act (INA) section
319(b).) If your residential address is outside the United States and you are filing under Section 319(b), select the
USCIS Field Office from the list below where you would like to have your naturalization interview:
D. Are applying on the basis of qualifying military service.

E. Other (Explain):
Part 2. Information About You (Person applying for naturalization)

1. Your Current Legal Name (do not provide a nickname)
Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)
GAHUTU DESIRE
2. Your Name Exactly As It Appears on Your Permanent Resident Card (if applicable)
GAHUTU DESIRE
Form N-400 Edition 09/17/19 Page 1 of 20

Part 2. Information About You (Person applying for naturalization) (continued) A- 2 1 2 6 7 2 1 8 6
3. Other Names You Have Used Since Birth (include nicknames, aliases, and maiden name, if applicable)
4. Name Change (Optional)

Read the Form N-400 Instructions before you decide whether or not you would like to legally change your name.
Would you like to legally change your name? Yes No
If you answered ''Yes," type or print the new name you would like to use in the spaces provided below.
5. U.S. Social Security Number (if applicable) 6. USCIS Online Account Number (if any)
► 6 6 9 0 8 8 1 3 4 ►
7. Gender 8. Date of Birth 9. Date You Became a Lawful

Male Female (mm/dd/yyyy) Permanent Resident (mm/dd/yyyy)
01/01/1960 08/06/2014
10. Country of Birth 11. Country of Citizenship or Nationality

DRCONGO DRCONGO
12. Do you have a physical or developmental disability or mental impairment that prevents you from Yes No
demonstrating your knowledge and understanding of the English language and/or civics requirements
for naturalization?
If you answered "Yes," submit a completed Form N-648, Medical Certification for Disability Exceptions, when you file your
Form N-400.
13. Exemptions from the English Language Test
A. Are you 50 years of age or older and have you lived in the United States as a lawful permanent Yes No
resident for periods totaling at least 20 years at the time you file your Form N-400?
B. Are you 55 years of age or older and have you lived in the United States as a lawful permanent Yes No
resident for periods totaling at least 15 years at the time you file your Form N-400?
C. Are you 65 years of age or older and have you lived in the United States as a lawful permanent Yes No
resident for periods totaling at least 20 years at the time you file your Form N-400? (If you meet
this requirement, you will also be given a simplified version of the civics test.)
Part 3. Accommodations for Individuals With Disabilities and/or Impairments

NOTE: Read the information in the Form N-400 Instructions before completing this part.
1. Are you requesting an accommodation because of your disabilities and/or impairments? Yes No
If you answered "Yes," select any applicable box.
A. I am deaf or hard of hearing and request the following accommodation. (If you are requesting a sign-language
interpreter, indicate for which language (for example, American Sign Language).)
B. I am blind or have low vision and request the following accommodation:

Part 3. Accommodations for Individuals With Disabilities and/or A- 2 1 2 6 7 2 1 8 6
Impairments (continued)
C. I have another type of disability and/or impairment (for example, use a wheelchair). (Describe the nature of your
disability and/or impairment and the accommodation you are requesting.)
Part 4. Information to Contact You

1. Daytime Telephone Number 2. Work Telephone Number (if any)
3158839803
3. Evening Telephone Number 4. Mobile Telephone Number (if any)

3158839803 3158839803
5. Email Address (if any)
Part 5. Information About Your Residence

1. Where have you lived during the last five years? Provide your most recent residence and then list every location where you
have lived during the last five years. If you need extra space, use additional sheets of paper.
A. Current Physical Address
Street Number and Name Apt. Ste. Flr. Number
1530 SUNSET AVE 1 LEFT
City or Town County State ZIP Code + 4
UTICA NY 13502 -
(USPS ZIP Code Lookup)
Province or Region Postal Code Country
(foreign address only) (foreign address only) (foreign address only)
USA
Dates of From (mm/dd/yyyy) To (mm/dd/yyyy)

Residence 01/01/2017 Present
B. Current Mailing Address (if different from the address above)

In Care Of Name (if any)

-


Part 5. Information About Your Residence (continued) A- 2 1 2 6 7 2 1 8 6
C. Physical Address 2
919 BLANDINA ST 2
UTICA NY 13501 -
USA

Residence 10/01/2014 01/01/2017
D. Physical Address 3

-

Residence
E. Physical Address 4

-


Residence
Part 6. Information About Your Parents

If neither one of your parents is a United States citizen, then skip this part and go to Part 7.
1. Were your parents married before your 18th birthday? Yes No
Information About Your Mother

2. Is your mother a U.S. citizen? Yes No
If you answered "Yes," complete the following information. If you answered "No," go to Item Number 3.

Part 6. Information About Your Parents (continued) A- 2 1 2 6 7 2 1 8 6
A. Current Legal Name of U.S. Citizen Mother
B. Mother's Country of Birth C. Mother's Date of Birth (mm/dd/yyyy)
D. Date Mother Became a U.S. Citizen E. Mother's A-Number

(if known) (mm/dd/yyyy) (if any)
► A-
Information About Your Father

3. Is your father a U.S. citizen? Yes No
If you answered ''Yes," complete the information below. If you answered "No," go to Part 7.
A. Current Legal Name of U.S. Citizen Father

B. Father's Country of Birth C. Father's Date of Birth (mm/dd/yyyy)
D. Date Father Became a U.S. Citizen E. Father's A-Number

(if known) (mm/dd/yyyy) (if any)
► A-
Part 7. Biographic Information

NOTE: USCIS requires you to complete the categories below to conduct background checks. (See the Form N-400 Instructions for
more information.)
1. Ethnicity (Select only one box)
Hispanic or Latino Not Hispanic or Latino
2. Race (Select all applicable boxes)

White Asian Black or American Indian Native Hawaiian or
African American or Alaska Native Other Pacific Islander
3. Height Feet 5 Inches 7 4. Weight Pounds 1 6 0
5. Eye color (Select only one box)

Black Blue Brown Gray Green Hazel Maroon Pink Unknown/
Other
6. Hair color (Select only one box)
Bald Black Blond Brown Gray Red Sandy White Unknown/
(No hair) Other

Part 8. Information About Your Employment and Schools You Attended A- 2 1 2 6 7 2 1 8 6
List where you have worked or attended school full time or part time during the last five years. Provide information for the complete time
period. Include all military, police, and/or intelligence service. Begin by providing information about your most recent or current
employment, studies, or unemployment (if applicable). Provide the locations and dates where you worked, were self-employed, were
unemployed, or have studied for the last five years. If you worked for yourself, type or print "self-employed." If you were unemployed,
type or print "unemployed." If you need extra space, use additional sheets of paper.
1. Employer or School Name

1530 EXPRESSWAY PLAZA 221
City or Town State ZIP Code + 4
ROSELYN HEIGHTS NY 11577 -
USA
Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Your Occupation
01/01/2017 03/01/2020 CONSTRUCTION

-

-

Part 9. Time Outside the United States A- 2 1 2 6 7 2 1 8 6
1. How many total days (24 hours or longer) did you spend outside the United States during the last 5 years? 0 days
2. How many trips of 24 hours or longer have you taken outside the United States during the last 5 years? 0 trips
3. List below all the trips of 24 hours or longer that you have taken outside the United States during the last 5 years. Start with
your most recent trip and work backwards. If you need extra space, use additional sheets of paper.
Date You Left the Date You Returned Did Trip Last Countries to Total Days
United States to the United States 6 Months or Which You Outside the
(mm/dd/yyyy) (mm/dd/yyyy) More? Traveled United States
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Part 10. Information About Your Marital History

1. What is your current marital status?
Single, Never Married Married Divorced Widowed Separated Marriage Annulled
If you are single and have never married, go to Part 11.
2. If you are married, is your spouse a current member of the U.S. armed forces? Yes No
3. How many times have you been married (including annulled marriages, marriages to other people, and 1
marriages to the same person)?
4. If you are married now, provide the following information about your current spouse.
A. Current Spouse's Legal Name
B. Current Spouse's Previous Legal Name

C. Other Names Used by Current Spouse (include nicknames, aliases, and maiden name, if applicable)
D. Current Spouse's Date of Birth E. Date You Entered into Marriage

(mm/dd/yyyy) with Current Spouse (mm/dd/yyyy)

Part 10. Information About Your Marital History (continued) A- 2 1 2 6 7 2 1 8 6
F. Current Spouse's Present Home Address

-

G. Current Spouse's Current Employer or Company
5. Is your current spouse a U.S. citizen? Yes No

If you answered ''Yes," answer Item Number 6. If you answered ''No," go to Item Number 7.
6. If your current spouse is a U.S. citizen, complete the following information.
A. When did your current spouse become a U.S. citizen?
At Birth - Go to Item Number 8. Other - Complete the following information.
B. Date Your Current Spouse Became

a U.S. Citizen (mm/dd/yyyy)
7. If your current spouse is not a U.S. citizen, complete the following information.
A. Current Spouse's Country of Citizenship or Nationality B. Current Spouse's A-Number (if any)
DRCONGO ► A-
C. Current Spouse's Immigration Status

Lawful Permanent Resident Other (Explain):
8. How many times has your current spouse been married (including annulled marriages, marriages to 1
other people, and marriages to the same person)? If your current spouse has been married before,
provide the following information about your current spouse's prior spouse.
If your current spouse has had more than one previous marriage, provide that information on additional sheets of paper.
A. Legal Name of My Current Spouse's Prior Spouse
B. Immigration Status of My Current Spouse's Prior Spouse (if known)

U.S. Citizen Lawful Permanent Resident Other (Explain):
C. Date of Birth of My Current Spouse's D. Country of Birth of My Current Spouse's

Prior Spouse (mm/dd/yyyy) Prior Spouse
E. Country of Citizenship or Nationality of My Current

Spouse's Prior Spouse

Part 10. Information About Your Marital History (continued) A- 2 1 2 6 7 2 1 8 6
F. My Current Spouse's Date of Marriage G. Date My Current Spouse's Marriage Ended
with Prior Spouse (mm/dd/yyyy) with Prior Spouse (mm/dd/yyyy)
H. How My Current Spouse's Marriage Ended with Prior Spouse

Annulled Divorced Spouse Deceased Other (Explain):
9. If you were married before, provide the following information about your prior spouse. If you have more than one previous
marriage, provide that information on additional sheets of paper.
A. My Prior Spouse's Legal Name
B. My Prior Spouse's Immigration Status When My Marriage Ended (if known)

U.S. Citizen Lawful Permanent Resident Other (Explain):
C. My Prior Spouse's Date of Birth D. My Prior Spouse's Country

(mm/dd/yyyy) of Birth
E. My Prior Spouse's Country of F. Date of Marriage with My Prior

Citizenship or Nationality Spouse (mm/dd/yyyy)
G. Date Marriage Ended with My

Prior Spouse (mm/dd/yyyy)
H. How Marriage Ended with My Prior Spouse

Annulled Divorced Spouse Deceased Other (Explain):
Part 11. Information About Your Children

1. Indicate your total number of children. (You must indicate ALL children, including: children who are alive, 8
missing, or deceased; children born in the United States or in other countries; children under 18 years of age or
older; children who are currently married or unmarried; children living with you or elsewhere; current
stepchildren; legally adopted children; and children born when you were not married.)
2. Provide the following information about all your children (sons and daughters) listed in Item Number 1., regardless of age.
To list any additional children, use additional sheets of paper.
A. Child 1
Current Legal Name
MUKANGANGO FURAHA
A-Number (if any) Date of Birth (mm/dd/yyyy) Country of Birth
► A- 2 1 2 6 7 2 1 8 5 01/01/2000 RWANDA

Part 11. Information About Your Children (continued) A- 2 1 2 6 7 2 1 8 6
Current Address
1018 BRINCKERHOFF AVE 1
UTICA NY 13501 -
USA
What is your child's relationship to you? (for example, biological child, BIOLOGICAL
stepchild, legally adopted child)
B. Child 2
Current Legal Name
NYIRABAKAMYI ANGELIQUE

► A- 2 1 2 6 7 2 1 8 4 01/01/2002 RWANDA
Current Address
UTICA NY 13502 -
USA
C. Child 3
Current Legal Name
NIYOMUNGERI MUHIRE
► A- 2 1 2 6 7 2 1 8 9 01/01/2005 RWANDA

Part 11. Information About Your Children (continued) A- 2 1 2 6 7 2 1 8 6
Current Address
UTICA NY 13502 -
USA
D. Child 4
Current Legal Name
MUHORAKEYE FIFI
► A- 2 1 2 6 7 2 2 0 6 01/01/1991 DRCONGO
Current Address
1012 BLEECKER ST 2
UTICA NY 13501 -
USA
Part 12. Additional Information About You (Person Applying for Naturalization)
Answer Item Numbers 1. - 21. If you answer "Yes" to any of these questions, include a typed or printed explanation on additional
sheets of paper.
1. Have you EVER claimed to be a U.S. citizen (in writing or any other way)? Yes No
2. Have you EVER registered to vote in any Federal, state, or local election in the United States? Yes No
3. Have you EVER voted in any Federal, state, or local election in the United States? Yes No
4. A. Do you now have, or did you EVER have, a hereditary title or an order of nobility in any foreign Yes No
country?
B. If you answered "Yes," are you willing to give up any inherited titles or orders of nobility that you Yes No
have in a foreign country at your naturalization ceremony?
5. Have you EVER been declared legally incompetent or been confined to a mental institution? Yes No

Part 12. Additional Information About You (Person Applying for A- 2 1 2 6 7 2 1 8 6
Naturalization) (continued)
6. Do you owe any overdue Federal, state, or local taxes? Yes No
7. A. Have you EVER not filed a Federal, state, or local tax return since you became a lawful permanent Yes No
resident?
B. If you answered "Yes," did you consider yourself to be a "non-U.S. resident"? Yes No
8. Have you called yourself a "non-U.S. resident" on a Federal, state, or local tax return since you became a Yes No
lawful permanent resident?
9. A. Have you EVER been a member of, involved in, or in any way associated with, any organization, Yes No
association, fund, foundation, party, club, society, or similar group in the United States or in any other
location in the world?
B. If you answered "Yes," provide the information below. If you need extra space, attach the names of the other groups on
additional sheets of paper and provide any evidence to support your answers.
Name Purpose Dates of Membership

of the of the From To
Group Group (mm/dd/yyyy) (mm/dd/yyyy)
10. Have you EVER been a member of, or in any way associated (either directly or indirectly) with:
A. The Communist Party? Yes No
B. Any other totalitarian party? Yes No
C. A terrorist organization? Yes No
11. Have you EVER advocated (either directly or indirectly) the overthrow of any government by force or Yes No
violence?
12. Have you EVER persecuted (either directly or indirectly) any person because of race, religion, national Yes No
origin, membership in a particular social group, or political opinion?
13. Between March 23, 1933 and May 8, 1945, did you work for or associate in any way (either directly or
indirectly) with:
A. The Nazi government of Germany? Yes No
B. Any government in any area occupied by, allied with, or established with the help of the Nazi Yes No
government of Germany?
C. Any German, Nazi, or S.S. military unit, paramilitary unit, self-defense unit, vigilante unit, citizen unit, Yes No
police unit, government agency or office, extermination camp, concentration camp, prisoner of war
camp, prison, labor camp, or transit camp?

14. Were you EVER involved in any way with any of the following:
A. Genocide? Yes No
B. Torture? Yes No
C. Killing, or trying to kill, someone? Yes No
D. Badly hurting, or trying to hurt, a person on purpose? Yes No
E. Forcing, or trying to force, someone to have any kind of sexual contact or relations? Yes No
F. Not letting someone practice his or her religion? Yes No
15. Were you EVER a member of, or did you EVER serve in, help, or otherwise participate in, any of the
following groups:
A. Military unit? Yes No
B. Paramilitary unit (a group of people who act like a military group but are not part of the official Yes No
military)?
C. Police unit? Yes No
D. Self-defense unit? Yes No
E. Vigilante unit (a group of people who act like the police, but are not part of the official police)? Yes No
F. Rebel group? Yes No
G. Guerrilla group (a group of people who use weapons against or otherwise physically attack the Yes No
military, police, government, or other people)?
H. Militia (an army of people, not part of the official military)? Yes No
I. Insurgent organization (a group that uses weapons and fights against a government)? Yes No
16. Were you EVER a worker, volunteer, or soldier, or did you otherwise EVER serve in any of the following:
A. Prison or jail? Yes No
B. Prison camp? Yes No
C. Detention facility (a place where people are forced to stay)? Yes No
D. Labor camp (a place where people are forced to work)? Yes No
E. Any other place where people were forced to stay? Yes No
17. Were you EVER a part of any group, or did you EVER help any group, unit, or organization that used a Yes No
weapon against any person, or threatened to do so?
A. If you answered "Yes," when you were part of this group, or when you helped this group, did you ever Yes No
use a weapon against another person?
B. If you answered "Yes," when you were part of this group, or when you helped this group, did you ever Yes No
tell another person that you would use a weapon against that person?
18. Did you EVER sell, give, or provide weapons to any person, or help another person sell, give, or provide Yes No
weapons to any person?
A. If you answered "Yes," did you know that this person was going to use the weapons against another Yes No
person?
B. If you answered "Yes," did you know that this person was going to sell or give the weapons to Yes No
someone who was going to use them against another person?

19. Did you EVER receive any type of military, paramilitary (a group of people who act like a military group Yes No
but are not part of the official military), or weapons training?
20. Did you EVER recruit (ask), enlist (sign up), conscript (require), or use any person under 15 years of age Yes No
to serve in or help an armed force or group?
21. Did you EVER use any person under 15 years of age to do anything that helped or supported people in Yes No
combat?
If any of Item Numbers 22. - 28. apply to you, you must answer "Yes" even if your records have been sealed, expunged, or
otherwise cleared. You must disclose this information even if someone, including a judge, law enforcement officer, or attorney, told
you that it no longer constitutes a record or told you that you do not have to disclose the information.
22. Have you EVER committed, assisted in committing, or attempted to commit, a crime or offense for which Yes No
you were NOT arrested?
23. Have you EVER been arrested, cited, or detained by any law enforcement officer (including any Yes No
immigration official or any official of the U.S. armed forces) for any reason?
24. Have you EVER been charged with committing, attempting to commit, or assisting in committing a crime Yes No
or offense?
25. Have you EVER been convicted of a crime or offense? Yes No
26. Have you EVER been placed in an alternative sentencing or a rehabilitative program (for example, Yes No
diversion, deferred prosecution, withheld adjudication, deferred adjudication)?
27. A. Have you EVER received a suspended sentence, been placed on probation, or been paroled? Yes No
B. If you answered "Yes," have you completed the probation or parole? Yes No
28. A. Have you EVER been in jail or prison? Yes No

B. If you answered "Yes," how long were you in jail or prison? Years Months Days
29. If you answered "No" to ALL questions in Item Numbers 23. - 28., then skip this item and go to Item Number 30.
If you answered "Yes" to any question in Item Numbers 23. - 28., then complete this table. If you need extra space, use
additional sheets of paper and provide any evidence to support your answers.
Why were you Date arrested, cited, Where were you Outcome or disposition of the
arrested, cited, detained, or arrested, cited, detained, or arrest, citation, detention, or
detained, or charged. charged? (City or Town, charge (no charges filed, charges
charged? (mm/dd/yyyy) State, Country) dismissed, jail, probation, etc.)

Answer Item Numbers 30. - 46. If you answer "Yes" to any of these questions, except Item Numbers 37. and 38., include a typed or
printed explanation on additional sheets of paper and provide any evidence to support your answers.
30. Have you EVER:

A. Been a habitual drunkard? Yes No
B. Been a prostitute, or procured anyone for prostitution? Yes No
C. Sold or smuggled controlled substances, illegal drugs, or narcotics? Yes No
D. Been married to more than one person at the same time? Yes No
E. Married someone in order to obtain an immigration benefit? Yes No
F. Helped anyone to enter, or try to enter, the United States illegally? Yes No
G. Gambled illegally or received income from illegal gambling? Yes No
H. Failed to support your dependents or to pay alimony? Yes No
I. Made any misrepresentation to obtain any public benefit in the United States? Yes No
31. Have you EVER given any U.S. Government officials any information or documentation that was false, Yes No
fraudulent, or misleading?
32. Have you EVER lied to any U.S. Government officials to gain entry or admission into the United States or Yes No
to gain immigration benefits while in the United States?
33. Have you EVER been removed, excluded, or deported from the United States? Yes No
34. Have you EVER been ordered removed, excluded, or deported from the United States? Yes No
35. Have you EVER been placed in removal, exclusion, rescission, or deportation proceedings? Yes No
36. Are removal, exclusion, rescission, or deportation proceedings (including administratively closed Yes No
proceedings) currently pending against you?
37. Have you EVER served in the U.S. armed forces? Yes No
38. A. Are you currently a member of the U.S. armed forces? Yes No
B. If you answered "Yes," are you scheduled to deploy overseas, including to a vessel, within the next Yes No
three months? (Refer to the Address Change section in the Instructions on how to notify USCIS if
you learn of your deployment plans after you file your Form N-400.)
C. If you answered "Yes," are you currently stationed overseas? Yes No
39. Have you EVER been court-martialed, administratively separated, or disciplined, or have you received an Yes No
other than honorable discharge, while in the U.S. armed forces?
40. Have you EVER been discharged from training or service in the U.S. armed forces because you were an Yes No
alien?
41. Have you EVER left the United States to avoid being drafted in the U.S. armed forces? Yes No
42. Have you EVER applied for any kind of exemption from military service in the U.S. armed forces? Yes No
43. Have you EVER deserted from the U.S. armed forces? Yes No

44. A. Are you a male who lived in the United States at any time between your 18th and 26th birthdays? Yes No
(This does not include living in the United States as a lawful nonimmigrant.)
B. If you answered "Yes," when did you register for the Selective Service? Provide the information below.
Date Registered Selective Service
(mm/dd/yyyy) Number
C. If you answered "Yes," but you did not register with the Selective Service System and you are:
1. Still under 26 years of age, you must register before you apply for naturalization, and complete the Selective Service
information above; OR
2. Now 26 to 31 years of age (29 years of age if you are filing under INA section 319(a)), but you did not register with the
Selective Service, you must attach a statement explaining why you did not register, and provide a status information
letter from the Selective Service.
Answer Item Numbers 45. - 50. If you answer ''No'' to any of these questions, include a typed or printed explanation on additional
sheets of paper and provide any evidence to support your answers.
45. Do you support the Constitution and form of Government of the United States? Yes No
46. Do you understand the full Oath of Allegiance to the United States? Yes No
47. Are you willing to take the full Oath of Allegiance to the United States? Yes No
48. If the law requires it, are you willing to bear arms on behalf of the United States? Yes No
49. If the law requires it, are you willing to perform noncombatant services in the U.S. armed forces? Yes No
50. If the law requires it, are you willing to perform work of national importance under civilian direction? Yes No
Part 13. Applicant's Statement, Certification, and Signature

NOTE: Read the Penalties section of the Form N-400 Instructions before completing this part.
Applicant's Statement
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1. Applicant's Statement Regarding the Interpreter
A. I can read and understand English, and I have read and understand every question and instruction on this application
and my answer to every question.
B. The interpreter named in Part 14. read to me every question and instruction on this application and my answer to every
question in KINYARWANDA , a language in which I am fluent, and I understood everything.
2. Applicant's Statement Regarding the Preparer

At my request, the preparer named in Part 15., PAUL NDAHIGWA ,
prepared this application for me based only upon information I provided or authorized.

Part 13. Applicant's Statement, Certification, and Signature (continued) A- 2 1 2 6 7 2 1 8 6
Applicant's Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of
my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.
I further authorize release of information contained in this application, in supporting documents, and in my USCIS records to other
entities and persons where necessary for the administration and enforcement of U.S. immigration laws.
I understand that USCIS will require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or
signature) and, at that time, I will be required to sign an oath reaffirming that:
1) I reviewed and provided or authorized all of the information in my application;
2) I understood all of the information contained in, and submitted with, my application; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the
information contained in, and submitted with, my application, and that all of this information is complete, true, and correct.
Applicant's Signature
3. Applicant's Signature Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
Instructions, USCIS may deny your application.
Part 14. Interpreter's Contact Information, Certification, and Signature

Provide the following information about the interpreter.
Interpreter's Full Name

1. Interpreter's Family Name (Last Name) Interpreter's Given Name (First Name)
NDAHIGWA PAUL
2. Interpreter's Business or Organization Name (if any)
Interpreter's Mailing Address

3. Street Number and Name Apt. Ste. Flr. Number
4509 S WILLIAMS ST
AMAILLO TX 79118 -
Province Postal Code Country

USA

Part 14. Interpreter's Contact Information, Certification, and Signature A- 2 1 2 6 7 2 1 8 6
(continued)
Interpreter's Contact Information

4. Interpreter's Daytime Telephone Number 5. Interpreter's Mobile Telephone Number (if any)
8062363036 8062363036
6. Interpreter's Email Address (if any)
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and KINYARWANDA , which is the same language specified in Part 13., Item B. in
Item Number 1., and I have read to this applicant in the identified language every question and instruction on this application and his
or her answer to every question. The applicant informed me that he or she understands every instruction, question and answer on the
application, including the Applicant's Certification and has verified the accuracy of every answer.
Interpreter's Signature
7. Interpreter's Signature Date of Signature (mm/dd/yyyy)
Part 15. Contact Information, Declaration, and Signature of the Person Preparing This Application, if
Other Than the Applicant
Provide the following information about the preparer.
Preparer's Full Name

1. Preparer's Family Name (Last Name) Preparer's Given Name (First Name)
NDAHIGWA PAUL
2. Preparer's Business or Organization Name (if any)
Preparer's Mailing Address

3. Street Number and Name Apt. Ste. Flr. Number
4509 S WILLIAMS ST

AMARILLO TX 79118 -
Province Postal Code Country

USA

Part 15. Contact Information, Declaration, and Signature of the Person A- 2 1 2 6 7 2 1 8 6
Preparing This Application, if Other Than the Applicant (continued)
Preparer's Contact Information

4. Preparer's Daytime Telephone Number 5. Preparer's Mobile Telephone Number (if any)
8062363036 8062363036
6. Preparer's Email Address (if any)
Preparer's Statement
7. A. I am not an attorney or accredited representative but have prepared this application on behalf of
the applicant and with the applicant's consent.
B. I am an attorney or accredited representative and my representation of the applicant in this case
extends does not extend beyond the preparation of this application.
NOTE: If you are an attorney or accredited representative whose representation extends beyond
preparation of this application, you may be obliged to submit a completed Form G-28, Notice of
Entry of Appearance as Attorney or Accredited Representative, with this application.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then
reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted
with, his or her application, including the Applicant's Certification, and that all of this information is complete, true, and correct. I
completed this application based only on information that the applicant provided to me or authorized me to obtain or use.
Preparer's Signature
8. Preparer's Signature Date of Signature (mm/dd/yyyy)
NOTE: Do not complete Parts 16., 17., or 18. until the USCIS Officer instructs you to do so at the
interview.
Part 16. Signature at Interview

I swear (affirm) and certify under penalty of perjury under the laws of the United States of America that I know that the contents of
this Form N-400, Application for Naturalization, subscribed by me, including corrections number 1 through ____________, are
complete, true, and correct. The evidence submitted by me on numbered pages 1 through ________________ are complete, true, and
correct.
Subscribed to and sworn to (affirmed) before me
USCIS Officer's Printed Name or Stamp Date of Signature (mm/dd/yyyy)
Applicant's Signature USCIS Officer's Signature

Part 17. Renunciation of Foreign Titles A- 2 1 2 6 7 2 1 8 6
If you answered "Yes" to Part 12., Items A. and B. in Item Number 4., then you must affirm the following before a USCIS officer:
I further renounce the title of which I have heretofore held; or

(list titles)
I further renounce the order of nobility of to which I have heretofore belonged.

(list order of nobility)
Applicant's Printed Name Applicant's Signature
USCIS Officer's Printed Name USCIS Officer's Signature
Date of Signature (mm/dd/yyyy)
Part 18. Oath of Allegiance

If your application is approved, you will be scheduled for a public oath ceremony at which time you will be required to take the
following Oath of Allegiance immediately prior to becoming a naturalized citizen. By signing below you acknowledge your
willingness and ability to take this oath:
I hereby declare on oath, that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince, potentate,
state, or sovereignty, of whom or which I have heretofore been a subject or citizen;
that I will support and defend the Constitution and laws of the United States of America against all enemies, foreign, and domestic;
that I will bear true faith and allegiance to the same;
that I will bear arms on behalf of the United States when required by the law;
that I will perform noncombatant service in the armed forces of the United States when required by the law;
that I will perform work of national importance under civilian direction when required by the law; and
that I take this obligation freely, without any mental reservation or purpose of evasion; so help me God.
Applicant's Printed Name

Applicant's Signature Date of Signature (mm/dd/yyyy)

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Application for Naturalization USCIS

Date Stamp Receipt Action Block

1. You are at least 18 years of age and:

D. Are applying on the basis of qualifying military service.

Part 2. Information About You (Person applying for naturalization)

Form N-400 Edition 09/17/19 Page 1 of 20

4. Name Change (Optional)

7. Gender 8. Date of Birth 9. Date You Became a Lawful

10. Country of Birth 11. Country of Citizenship or Nationality

Part 3. Accommodations for Individuals With Disabilities and/or Impairments

B. I am blind or have low vision and request the following accommodation:

Form N-400 Edition 09/17/19 Page 2 of 20

Part 4. Information to Contact You

3. Evening Telephone Number 4. Mobile Telephone Number (if any)

5. Email Address (if any)

Part 5. Information About Your Residence

Dates of From (mm/dd/yyyy) To (mm/dd/yyyy)

B. Current Mailing Address (if different from the address above)

Street Number and Name Apt. Ste. Flr. Number

City or Town County State ZIP Code + 4

Province or Region Postal Code Country

Form N-400 Edition 09/17/19 Page 3 of 20

Dates of From (mm/dd/yyyy) To (mm/dd/yyyy)

City or Town County State ZIP Code + 4

Dates of From (mm/dd/yyyy) To (mm/dd/yyyy)

City or Town County State ZIP Code + 4

Province or Region Postal Code Country

Dates of From (mm/dd/yyyy) To (mm/dd/yyyy)

Part 6. Information About Your Parents

1. Were your parents married before your 18th birthday? Yes No

Information About Your Mother

Form N-400 Edition 09/17/19 Page 4 of 20

B. Mother's Country of Birth C. Mother's Date of Birth (mm/dd/yyyy)

D. Date Mother Became a U.S. Citizen E. Mother's A-Number

Information About Your Father

A. Current Legal Name of U.S. Citizen Father

B. Father's Country of Birth C. Father's Date of Birth (mm/dd/yyyy)

D. Date Father Became a U.S. Citizen E. Father's A-Number

Part 7. Biographic Information

2. Race (Select all applicable boxes)

3. Height Feet 5 Inches 7 4. Weight Pounds 1 6 0

5. Eye color (Select only one box)

Form N-400 Edition 09/17/19 Page 5 of 20

Street Number and Name Apt. Ste. Flr. Number

2. Employer or School Name

Street Number and Name Apt. Ste. Flr. Number

City or Town State ZIP Code + 4

Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Your Occupation

3. Employer or School Name

Street Number and Name Apt. Ste. Flr. Number

City or Town State ZIP Code + 4

Date From (mm/dd/yyyy) Date To (mm/dd/yyyy) Your Occupation

Form N-400 Edition 09/17/19 Page 6 of 20

Part 10. Information About Your Marital History

B. Current Spouse's Previous Legal Name

D. Current Spouse's Date of Birth E. Date You Entered into Marriage

Form N-400 Edition 09/17/19 Page 7 of 20

City or Town County State ZIP Code + 4

Province or Region Postal Code Country