When filing Form N-565, Application for Replacement Naturalization/Citizenship Document, on the basis of a certificate that was lost, stolen or destroyed, the applicant should submit evidence of the loss. U.S. Citizenship and Immigration Services (USCIS) simply wants an explanation (and proof) of what happened. Generally, the applicant must submit a police report and/or a sworn statement.
Contact the police authority in the jurisdiction that the naturalization certificate or citizenship document was lost or stolen. Ask how to obtain a police report for your situation. If a police report is unobtainable for any reason, you may submit a sworn statement instead.
A sworn statement is a declaration of the facts. It’s like testimony in a written form. Your statement should describe the circumstances of how, when and where your citizenship document was lost, stolen or destroyed.
A sworn statement does not need to be notarized. At the end of the sworn statement, include a sentence that says “I swear, under penalty of perjury, that the foregoing is true and correct to the best of my knowledge.”
N-565 Sample Sworn Statement
CitizenPath makes the following N-565 sample sworn statement to be used as an example. Do not submit the sworn statement on the following page without updating it to fit your specific situation.
Please refer to your custom filing instructions from CitizenPath for the USCIS mailing address, filing fee and requisite supporting documents to be submitted with Form N-565.