Monthly Report Naturalization Papers

• Legal Form Number: N-4
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form N-4 Edition 08/31/21 Page 1 of 2

In compliance with the naturalization laws and regulations, listed below are each oath administration ceremony conducted under the

jurisdiction of the above named court during the month and

Date of

Ceremony Court List Number Place of Ceremony Number of Persons

Administered Oath Number of

Voided Certificates

(County or District)

(City, State, and Zip Code)

By

(Clerk of Court)

(Deputy Clerk)

Date: Office of the Clerk of the Court

U.S. Citizenship and Immigration Services:

year.

I have also enclosed the duplicate court list endorsed by me as clerk of the above named court during the same month, except for those

that have already been delivered personally to your representative. Those so delivered are indicated by an (*) next to the court list

number.

Also enclosed are ( ) voided Certificates of Naturalization. A specific listing of the voided certificates may be found on

each endorsed court list.

Monthly Report on Naturalization Papers

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form N-4

OMB No. 1615-0051

Expires 08/31/2024