EFTA00522965.pdf

N-445, Notice of Naturalization Oath Ceremony USCIS Form N-445 Department of Homeland Security OMB No. 1615.0054 U.S. Citizenship and Immigration Services Expires 06/30/2019 A-Number Date 05/11/2018 KARYNA SHULIAK KARYNA SHULIAK 6100 RED HOOK QUARTERS STE B3 ST THOMAS VI 00802 United States Citizenship and Immigration Services (USCIS) thanks you for your interest in becoming a United States citizen. You must now appear at a Naturalization Oath Ceremony to complete the naturalization process. You are scheduled to appear fora Naturalization Oath Ceremony on: Please bring the following with you: Date and Time: Wednesday, May 30, 2018 at 08:00AM • This notice with the reverse side completed. Please refer to Location: instructions on the reverse side. THIRD FLOOR FEDERAL BUILDING, UNITED STATES • Your Permanent Resident Card ("green tare). DISTRICT COURT • All Reentry Permits or Refugee Travel Documents you may ST THOMAS VI 00802 have, valid or expired. • Any other documents USCIS issued to you. The naturalization ceremony is a solemn and meaningful event. USCIS asks that you dress in proper attire to respect the dignity of this event. If you cannot come to this ceremony, return this notice immediately with a written explanation on why you cannot attend. You will then receive an appointment for a ceremony at a later date. If you require an accommodation, such as a sign language interpreter, please contact the USCIS National Customer Service Center at I-800-375-5283, at least 10 days prior to your scheduled ceremony. Please answer the questionnaire on the reverse side of this notice on the day of your scheduled ceremony. Print clearly in black ink. Please read the instructions before answering the questions, which concern events that may have occurred since your interview. — If you answer "YES" to any of the questions, bring documents to support your answers. For example, if you married or divorced after — your interview, bring your marriage certificate or divorce decree. If you were arrested after your interview, bring your arrest records and court dispositions. If you were serving in the military and have been discharged, bring your DD214 or other discharge papers. USCIS Privacy Act Statement AUTHORITIES: The information requested our this form, and the associated evidence, is collected pursuant to Sections 1010. 313, 316, 332. 334, 335 and 336 of the Immigration and Nationality Act (S U.S.C. sections 1101(0, 1424. 1427, 1443, 1445, 1446 and 1447). PURPOSE: The Ornery propose for providing the requested information on this form is to dnennine if you have maintained good moral chancier and other continued eligibility for naturalization from the dale of your last interview until the naturalization ceremony. DISCLOSURE; The intern:moon you provide is voluntary. However, failure to provide the requested informatioo, arid any requested evidence, may delay the date of your naturalization ceremony or result in denial of your request for naturalization. ROUTINE USES: The information you provide on this form may be shared with other federal, stale, local, and foreign government agencies and authorized organizations in accordance with approved routine uses. as described in the associated published system of records notices (DHS/USCIS.001 • Alien File, Index, and National File Tracking System of Records) which can be found at www,dbi,govfpriyary, The information may also be made available, as appropriate for law enforcement purposes or in the interest of national security. Paperwork Reduction Act The public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, sod completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to: U.S. Citizenship and Immigratioo Services, Regulatory Coordination Division, Office of Policy and Strategy. 20 Massachusetts Avenue. NW, Washington. DC 20529-2140; OMB No 1615.0054. Do not mall your completed Form N•445 to this address. Form N-445 10/31/16 N Page I of 2 EFTA00522965  For ❑Sworn Statement USCIS a 0 Name of Applicant KARYNA SHULLAK Use ❑Other A-Number Only FCO: 0 Instructions You MUST bring this completed questionnaire with you to the Naturalization Oath Ceremony, along with the documents listed on the front side of this notice. You are required to give these items to an employee of USCIS at the oath ceremony. Answer the following questions on the day of your Naturalization Oath Ceremony. Please note that these questions do not refer to any events that happened before your naturalization interview. These questions refer to the time period after your interview at the USCIS office. For example, if you were married at the time of your interview and there has been no change in your marital status since your interview, select "NO" to item Number I below. If you traveled outside the United States after your interview, select "YES" to Item Number 2 below. After you have answered each question, print the date and location (city and state) where you completed the questionnaire. Also, sip the questionnaire and print your current address. I. Since your interview, have you married, or been widowed, separated or divorced? ❑ Yes ❑ No 2. Since your interview, have you traveled outside the United States? ❑ Yes ❑ No 3. Since your interview, have you knowingly committed any crime or offense, for which you have not been arrested? ❑ Yes ❑ No 4. Since your interview, have you been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or ❑ Yes ❑ No violating any law or ordinance, including traffic violations? 5. Since your interview, have you joined, become associated, or connected with any organization in any way, including ❑ Yes ❑ No the Communist Party, a totalitarian organization, or terrorist group? 6. Since your interview, have you deserted from, claimed exemption from, or been separated or discharged from military ❑ Yes ❑ No service? 7. Since your interview, has there been any change in your willingness to bear arms on behalf of the United States; to perform non-combatant service in the armed forces of the United States; or to perform work of national importance ❑ Yes ❑ No under civilian direction if the law requires it? S. Since your interview, have you practiced polygamy, received income from illegal gambling, been involved in prostitution. helped anyone enter the United States illegally, trafficked controlled substances, given false testimony to ❑ Yes ❑ No obtain immigration benefits, or been a habitual drunkard? I certify that each answer shown above was made by me or at my direction, and that each answer is true and correct as of the date of my Naturalization Oath Ceremony. Signed at I on City and State Date Signature Full Address and ZIP Code Street Number and Name Apt. Ste. Flr. Number ❑ ❑ ❑ City or Town State ZIP Code Form N-445 10/31/16 N Page 2 of 2 EFTA00522966