LAW OFFICE OF
COUGLE LAW, L.L.C.
DAVID J. COUGLE, ESQ.
ATTORNEY AT LAW
NATURALIZATION QUESTIONNAIRE
I.
Information about the Applicant.
Birth Name
Other Names Used
Current Address
Home Phone Number
Country of Citizenship
Date of Birth
City, and Country of Birth
A Number
I-94 Number
Social Security Number or TIN
Date of Last Entry into the U.S.
Place of Last Entry
Manner of Last Entry (Visa)
Current Status and Expiration Date
U.S. Consulate that Issued Visa
Date of Issue
Number of Nonimmigrant Visa
Have you ever been in immigration proceedings? If so, please
explain
Height (Feet & Inches)
Weight (Pounds)
Eye Color
(a) Names of Prior Spouses, (b) Spouses’ Dates of Birth, (c) Dates
and places of previous marriages (month, day, year), and (d) dates
(month, day, year) and places marriages ended:
Address where you intend to live in the U.S
Address abroad
If native alphabet is other than Roman letters, give address in
native alphabet
Do you have any children from previous marriages or any
children anywhere in the world ?
M: P.O. Box 74, Pearl River, LA 70452
P: (985) 863-4565
F: (866) 365-1807
E: secretary@couglelaw.com
W: www.couglelaw.com
Have you been in the U.S. more than 183 days in any one of the
last three calendar years? If so, please explain.
Have you received income from a U.S. Source in the last five
years? If so, please explain
Annual salary for last 3 years
Have you filed a tax return in the last five years? If yes, please
provide
Date You Obtained your Permanent Residence
If you obtained permanent residence through a job offer, did you
work for the sponsoring employer through which permanent
residence was conferred?
How long did you work for such employer?
Port of Entry or USCIS office where you Adjusted
Presence within and without U.S.
Have you been outside of the U.S. for more than six months without interruption in the last
five years?
Yes or No
Please account for every absence from the U.S., with an exact starting and termination date
for each trip:
Location
Start Date
End Date
Have you been absent from the U.S. one year or more in the last five years?
Yes or No
Have you resided in the U.S. for the last three months?
Yes or No
Current Occupation
Parents
Father
Mother
Name
Date/City/Country of Birth
Current City/Country of
Residence
Please list all residences for the last five years, dates from and to in month/year
Address
M: P.O. Box 74, Pearl River, LA 70452
P: (985) 863-4565
Date From
F: (866) 365-1807
E: secretary@couglelaw.com
Date To
W: www.couglelaw.com
Please list all employment for the last five years, names/addresses, Title/Occupation, dates from/to in month/year
Name
Address
Title/Occupation
Date From
Date To
Have you ever before applied for permanent resident status in the U.S.?
If yes, give date and place of filing and final disposition
Do you have any criminal convictions in the U.S. or in
any other country?
Have you been on probation, parole, or suspended
sentence?
II. Processing Information
Have you ever, in or outside the U.S.:
Yes/No
Knowingly committed any crime of moral turpitude (including but not limited to theft,
fraud, forgery) or a drug-related offense for which you have not been arrested? You must
include even violations of minor municipal ordinances (but NOT traffic violations).
Been arrested, cited, charged, indicted, fined or imprisoned for breaking or violating any law
or ordinance, excluding traffic violations?
Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency or
similar action?
Exercised diplomatic immunity to avoid prosecution for a criminal offense in the U.S.?
Have you received public assistance in the U.S. from any source, including the U.S.
government or any state, county, city or municipality (other than emergency medical
treatment), or are you likely to receive public assistance in the future?
Have you ever:
Within the past ten years been a prostitute or procured anyone for prostitution, or intend to
engage in such activities in the future?
Engaged in any unlawful commercialized vice, including, but not limited to, illegal
gambling?
Knowingly encouraged, induced, assisted, abetted or aided any alien to try to enter the U.S.
illegally?
Illicitly trafficked in any controlled substance, or knowingly assisted, abetted, or colluded in
the illicit trafficking of any controlled substance?
M: P.O. Box 74, Pearl River, LA 70452
P: (985) 863-4565
F: (866) 365-1807
E: secretary@couglelaw.com
W: www.couglelaw.com
Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have
you ever solicited membership or funds for, or have you through any means ever assisted or
provided any type of material support to, any person or organization that has ever engaged
or conspired to engage, in sabotage, kidnapping, political assassination, hijacking or any
other form of terrorist activity?
Do you intend to engage in the U.S. in:
Espionage?
Any activity a purpose of which is opposition to, or the control or overthrow of, the
government of the United States, by force, violence or other unlawful means?
Any activity to violate or evade any law prohibiting the export from the United States of
goods, technology or sensitive information?
Have you ever been a member of, or in any way affiliated with, the Communist Party, or any
other totalitarian party?
Did you, during the period from March 23, 1933 to May 8, 1945, in association with either
the Nazi Government of Germany or any organization or government associated or allied
with the Nazi Government of Germany, ever order, incite, assist or otherwise participate in
the persecution of any person because of race, religion, national origin or political opinion?
Have you ever engaged in genocide, or otherwise ordered, incited, assisted or otherwise
participated in the killing of any person because of race, religion, nationality, ethnic origin
or political opinion?
Have you ever been deported from the U.S., or removed from the U.S. at government
expense, excluded within the past year, or are you now in exclusion or deportation
proceedings?
Are you under a final order of civil penalty for violating 274C of the Immigration and
Nationality Act for use of fraudulent documents or have you, by fraud or willful
misrepresentation of a material fact, ever sought to procure, or procured, a visa, other
documentation, entry into the U.S. or any immigration benefit?
Have you ever left the U.S. to avoid being drafted into the U.S. Armed Forces?
Have you ever been a J nonimmigrant exchange visitor who was subject to the two-year
foreign residence requirement and not yet complied with that requirement or obtained a
waiver?
Are you now withholding custody of a U.S. citizen outside the U.S. from person granted
custody of the child?
Do you plan to practice polygamy in the U.S.?
Have you ever claimed to be a U.S. Citizen?
Have you ever registered to vote in any local, state, or federal election?
Have you ever voted in any local, state, or federal election?
Do you owe any federal, state, or local taxes that are overdue?
Do you have any title of nobility in a foreign country?
Have you ever been declared legally incompetent or been confined to a mental institution
within the last five years?
M: P.O. Box 74, Pearl River, LA 70452
P: (985) 863-4565
F: (866) 365-1807
E: secretary@couglelaw.com
W: www.couglelaw.com
Have you ever committed a crime or offense for which you were not arrested?
Have you ever been arrested, cited, or detained by any law enforcement officer, including
USCIS/INS & military?
Have you ever been in jail or prison?
List your present or past memberships in or affiliations with every political organization, fund, association, foundation, club, society or similar group in the
U.S. or in any other place since your 16th birthday. Include any foreign military service in this part. Include names, locations, nature of org. and dates of
membership
Name
Address
Nature of Organization
Date From
Date To
Information about Dependents
List your present spouse and all daughters and sons:
Family Name
Given Name Middle Initial
A#
Relationship Country of Birth
Date of Birth
Current Marriage
Date of Marriage
Name of Spouse
Dates of Marriage
M: P.O. Box 74, Pearl River, LA 70452
Place of Marriage
Your Prior Marriages
Place of Marriage
Place of End of
Marriage
P: (985) 863-4565
F: (866) 365-1807
E: secretary@couglelaw.com
Divorced or Widowed
W: www.couglelaw.com
Name of Spouse
Dates of Marriage
Spouse's Prior Marriages
Place of Marriage
Place of End of
Marriage
Divorced or Widowed
IV. Required Documents
To Prepare and file your Naturalization application we will need the following documents. If you are
submitting this questionnaire for an initial consultation, you do not need to send us any of the documents at this
time.
 Two (2) Identical Passport size Photographs
 Complete Copy of Passport with all nonimmigrant visas, dates of entry included
 Certified English Translation of the Passport
 Copy of Alien Registration Card (Green Card), front and back
 Birth Certificate
 Certified English Translation of the Birth Certificate
 Marriage Certificate (if applying based on three years of marriage to a US citizen)
 Certified English Translation of the Marriage Certificate
 Divorce decree
 Certified English Translation of the Divorce Decree
 Federal Tax Returns for last five years
 Certified copies of court dispositions of criminal matters
I certify that the information I have provided herein is true and accurate. I have carefully read this
questionnaire, and I certify the information is true and complete.
Date___________________________________Signature___________________________________________
***THE USE OR SUBMISSION OF THIS QUESTIONNAIRE DOES NOT CONSTITUTE
REPRESENTATION BY COUGLE LAW, L.L.C., NOR SHALL IT BE CONSIDERED LEGAL ADVICE***
M: P.O. Box 74, Pearl River, LA 70452
P: (985) 863-4565
F: (866) 365-1807
E: secretary@couglelaw.com
W: www.couglelaw.com