Form N 643 – Fill Out and Use This PDF

Form N 643 is a crucial document that all business owners must have. It serves as a vital record that sets out the industry's corporate rules and minutiae. Having accurate details on this form helps you better optimize the executives, directors, and convene a noticeably improved overall result. Submitting Form N 643 contributes to your success in the professional scope; so it's encouraged to always have an up to date rendition. This form captures essential evidence of annual activity in regards to changes stemming from stock issues to communication regarding compliance. Furthermore, having these relevant perspectives documented can be appealed to authorities for legal Defense cases if needed as well.

Form N 643 PDF Details

The Form N-643 is an application for Supplemental Security Income (SSI) benefits. The form is used to request benefits for a disabled child, and can be filed by the child's parent, guardian, or other representative. The form asks for information about the child's medical history and current situation, as well as their family income and assets. Filling out the form correctly is important in order to ensure that the child receives the correct amount of SSI benefits.

Question	Answer
Form Name	Form N 643
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	n 643fillable application for certificate of citizenship in behalf of an adopted child form

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OMB# 1115-0152

U.S. Department of Justice

Immigration and Naturalization Service

Application for Certificate of Citizenship in Behalf of an Adopted Child

INSTRUCTIONS

Who may file? To use this form, you must be a United States citizen and the parent of an adopted child who was born outside the United States. Your spouse (if any) must also be a United States citizen and also the child's adoptive parent. The child must be under 18 years of age and residing with you in the United States as a lawfully admitted permanent resident alien. The approval of this application before the child's 18th birthday will make the child a United States citizen as of the date the application is approved. You will receive a certificate of citizenship as proof of the child's citizenship.

What is the fee? You must pay $145.00 to file this form. The fee will not be refunded. Do not mail cash. All checks or money orders must be payable in the U.S. currency in the United States. Make check or money order payable to "Immigration and Naturalization Service" in the exact amount. If the check is not honored, INS will charge you an additional $30.00.

If you live in Guam and are filing this application in Guam, make your check payable to "Treasurer, Guam," or if you live in the U.S. Virgin Islands and are filing this application there, make it payable to "Commissioner of Finance of the Virgin Islands."

What photographs are needed? You must send three identical, unglazed photographs of the child taken within 30 days of the date of filing of this application. The photographs must be in natural color and taken without a hat. The dimensions of the face should be about 1 inch from the top of the hair to the chin. The face should be a 3/4 frontal view with the entire right ear visible. They must be on thin paper with a Iight background and not mounted in any way. The photographs must not be signed but you should print the child's name and alien registration number in the center of the back of each photograph in pencil.

What documents are needed?.

Child's Alien Registration Card.

Child's Birth Certificate.

Final adoption decree.

If the child's name has been legally changed since entry, submit evidence of the name change if not included in the adoption decree.

Evidence of U.S. citizenship of adoptive parent(s). Submit your birth cerfificate, if born in the United States; your naturalization certificate, if naturalized; your certificate of citizenship or FS-240 (Report of Birth Abroad of United States Citizen). In place of any of the aforementioned, you may submit your valid, unexpired U.S. passport.

Marriage certificate of adoptive parents.

If either of the adoptive parents has been previously married, submit evidence of termination of all prior marriages.

Any document in a foreign language must be accompanied by a translation in English. The translator must certify that he or she is competent to translate and that the translation is accurate.

What if a document is not available? If the documents needed are not available you may submit the following (INS may require a certification from the appropriate civil authority that the document is not available):

Church record: A certificate under the church seal issued within two months of birth.

School record: A letter from authorities of the school attended.

Census records: State or Federal census record.

Affidavits: Written statements sworn (or affirmed) to by two persons who have personal knowledge of the claimed event.

For each document needed, you may submit the original documents or a clear, readable copy (INS may still require the originals).

Where should the application be filed?

Submit this application at the local INS office having jurisdiction over your place of residence.

What are the penalties for submitting false information? Title 18 United States Code, Section 1001, states that whoever willfully and knowingly falsifies a material fact, makes a false statement, or makes use of a false document will be fined up to $10,000 or imprisoned up to five years or both. In addition, civil penalties may be imposed in accordance with Title 8 United States Code, Section 1324c(a)(2).

What is the authority for collecting this information? Information on this form is requested to carry out the immigration laws contained in Title 8 United States Code 1304(c). This information is needed to determine whether an applicant is eligible for immigration benefits. The information provided may also be disclosed to other federal, state, local, and foreign law enforcement and regulatory agencies during the course of the investigation required by this Service. It is not necessary to provide this information, however, if you refuse, your application may be denied.

Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, an agency may not conduct or sponsor an information collection and a person is not required to respond to an information collection unless it displays a currently valid OMB control number. We try to create forms and instructions that are accurate, can be easily understood and which impose the least possible burden on you. Often this is difficult because some immigration laws are very complex. The estimated average time to complete and file this application is as follows: (1) 15 minutes to learn the law and form; (2) 20 minutes to complete the form; and (3) 30 minutes to assemble and file the petition, for a total estimated average of 1 hour and 5 minutes per petition. If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the Immigration and Naturalization Service, 425 I Street, NW, Room 4034, Washington DC 20536; OMB No. 1115-0152. DO NOT MAIL YOUR COMPLETED APPLICATION

TO THIS ADDRESS.

Form N-643 (12/06/01)Y Page1

	U.S. Department of Justice	OMB No. 1115-0152
	U.S. Department of Justice	Certificate of Citizenship on Behalf of Adopted Child
	Immigration and Naturalization Service	Certificate of Citizenship on Behalf of Adopted Child

START HERE - Please Type or Print

Part	Information about adopted child.

Last		First	Middle
Name

FOR INS USE ONLY

Returned	Receipt

Address:

Street

Number

City

Country

Date of Birth (Mo/Day/Yr)

Social Security #

Apt. #

State or

Province

ZIP/Postal

Code

Place of Birth

(City, Country)

Resubmitted

Reloc Sent

Reloc Rec'd

Personal Description:

Sex	Male	Female	Height Ft.	In.
Sex	Male	Female	Height Ft.	In.


Marital Status		Visible Marks or Scars

Information about Entry:

Name at Entry (If different from Item A)

Date of Entry			Place of Entry

Date of Adoption			Place of Adoption
(Mo/Day/Yr)			(City, Country)

Part B. Information about the Adoptive Parents (if there is only one parent write ''None'' in place of the name of the parent which does not apply.)

Last Name of Adoptive Father	First	Middle

U.S. Citizen b y: Birth in the U.S.

Birth abroad to USC parents (List certificate of citizenship number or passport number)

Naturalized or derived after birth (List naturalization certificate number)

Last Name of Adoptive Mother	First	Middle and Maiden

U.S. Citizen b y: Birth in the U.S.

Birth abroad to USC parents (List certificate of citizenship number or passport number)

Naturalized or derived after birth (List naturalization certificate number)

Applicant

Interviewed

Action Block

Recommendation of Officer:

Approval

Denial

Concurrence of District Director or Officer in Charge:

I do	do not	concur
Signature

Certificate #

To Be Completed by

Attorney or Representative, if any

Fill in box if G-28 is attached to represent the applicant

VOLAG#

ATTY State License #

Form N-643 (12/06/01) Y - Page 2

Date

of my knowledge, and that corrections numbered ( Signature of parent or guardian

) inclusive; that the same are true and correct to the best ) were made by me or at my request.

the attached supplementary pages numbered (

Daytime Telephone #

Part B. Continued.

Date and Place of Marriage of the Adoptive Parents

Number of Prior Marriages of Adoptive Father			Number of Prior Marriages of Adoptive Mother

Is residence of parents' the same as the child's?	YES	NO (If no, explain on a separate sheet of paper.)

If the residence address is different from Item A, list actual residence address.

Part C. Signature. (Read the information on penalties in the instructions before completing this section.)

I certify that this application, and the evidence submitted with it, is true and correct. I authorize the release of any information from my records, or that of my child which the Immigration and Naturalization Service needs to determine eligibility for the benefit I am seeking.

Signature	Print Name	Date

Part D. Signature of person preparing form, if other than above. (Sign below)

I declare that I prepared this application at the request of the above person and it is based on all information of which I have knowledge.

Signature	Print Name	Date

Firm Name

and Address

DO NOT COMPLETE THE FOLLOWING UNTIL INSTRUCTED TO DO SO AT THE INTERVIEW

AFFIDAVIT. I, the (parent, guardian)do swear or affirm, under penalty of

the perjury laws of the United States, that I know and understand the contents of this application signed by me, and ) to (

) to (

Person Examined	Address		Relationship to Applicant
Sworn or affirmed before me on		at
Signature of interviewing officer		Title

Form N-643 (12/06/01) Y- Page 3

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Step 1: First, access the pdf editor by pressing the "Get Form Button" above on this site.

Step 2: This editor grants the opportunity to modify your PDF document in a range of ways. Transform it with personalized text, correct original content, and put in a signature - all at your disposal!

This form will need particular info to be typed in, therefore you should take whatever time to type in exactly what is asked:

1. Whenever filling out the Form N 643, be certain to incorporate all necessary blank fields in its associated part. This will help speed up the process, enabling your details to be processed swiftly and appropriately.

2. After filling out the last section, go to the subsequent stage and complete the necessary details in these fields - Name at Entry If different from, Date of Entry, Place of Entry, Date of Adoption MoDayYr, Place of Adoption City Country, Part B Information about the, one parent write None in place of, Last Name of Adoptive Father, First, Middle, US Citizen b y, Birth in the US, Birth abroad to USC parents List, Naturalized or derived after birth, and Last Name of Adoptive Mother.

3. In this part, look at Part B Continued, Date and Place of Marriage of the, Number of Prior Marriages of, Number of Prior Marriages of, Is residence of parents the same, YES, NO If no explain on a separate, If the residence address is, Daytime Telephone, Part C Signature, Read the information on penalties, I certify that this application, Signature, Print Name, and Date. All of these have to be completed with greatest precision.

How you can prepare Form N 643 portion 3

Always be very attentive while filling out Part C Signature and Signature, as this is the part where many people make mistakes.

4. It's time to complete the next portion! In this case you'll have these Signature, Print Name, Date, Firm Name and Address, DO NOT COMPLETE THE FOLLOWING, AFFIDAVIT I the parent guardian, do swear or affirm under penalty of, the perjury laws of the United, inclusive that the same are true, were made by me or at my request, Signature of parent or guardian, Date, Person Examined, Address, and Relationship to Applicant form blanks to fill out.

Form N 643 conclusion process shown (portion 4)

Step 3: Go through all the details you have entered into the blank fields and then press the "Done" button. After starting afree trial account with us, you'll be able to download Form N 643 or send it through email immediately. The PDF will also be accessible from your personal cabinet with all your edits. Here at FormsPal, we do everything we can to be certain that your details are maintained private.

Form N 643 – Fill Out and Use This PDF

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