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OMB No 161540082; Expees 103100 Department of Homeland Security N*‘” Application U S Cunperhip and Immigration Servoes for Naturalization Print clearly or type your answers ssimg CAPITAL Metters, Falbare to print chearhy may delay your application. |se Mack ink. [ Part 1. Your Name.(The Person Appiying for Naturalization) | [ Write your USCIS “A™ nurmbr heve: A A Your current legal name Family Name (Lavt Name) For USCIS Use Only [ ] Bar Code { Date Stamp Given Name (Farst Nawe) Full Middle Name ¢If appiacahle) : [ Il J B. Your name exactly as it appears o your Permanent Resident Card Faumily Name (Lavt Name) [ J Griven Nume (Firsr Nawe) Full Maddle Name () applicatle) I Il | C.If you have ever wsed other names, provide them helow Family Name (Last Nawe) Given Name (First Name) Middle Name D. Name change (opuional) Plesse read the Tnstructions befare you decsde whether 5o change your maume. 1. Would you like %o legally change your name? D Yos D No 2. If "Yes," print the mew name you would like to use. Do not wse imitials or abbrevigtions when wriling your new name Action Block Family Name (Last Name) Given Name (Firsr Nawe) Full Middle Name [ I l Part 2, Information About Your Elgibility. (Check Only One) 1 am at keast 15 years old AND \ D | have been o Lawtul Permuncns Resident of the Laited States for at Jeast five years. B D 1 have been a Lawful Permanent Resadent of the United Stases for ot leass three years, and | have been mamied to and living with the same U S, citizen for the last three years, and my spousse has boen o US. citizen for the East three yeurs C D 1| am applying on the basis of qualifying milisary service., Other (Please explam) Form NAOO (Rev 110106)Y . Form N-400, Application for Naturalization - Kate L. Raynor