Suffolk County Archivist
Suffolk County Clerk's Office
310 Center Drive
Riverhead NY 11901-3392

Please note: The complete form must be submitted. If your signature is not included, no documents will be sent.

Dear Sir or Madam,

I am requesting a copy of all information associated with the naturalization of the following person:

Information from the Suffolk County Naturalization computer index:

______________________	__________________	_________	__________	_________________
Surname	Given Name	Volume #	Petition #	Index

Additional information: (if known)

____________	_________________________	__________________________________________
Birth Date	Birth Place	Address at time of petition or naturalization

______________________________________________________________________________________

Other names used

______________________________________________________________________________________

Other information (Parents or sponsors names)

Please send a copy of all information to: (Please print clearly)

Name: _________________________________________________________

Address: _______________________________________________________

City: _____________________ State: _____ Zip code: __________- _______

Telephone: (______)_________________ Email:________________________

Signed: ____________________________________________

(The Suffolk County Clerk's Office has decided that there will be no fee for this information. However we ask that you enclose a self-addressed stamped envelope to help both defray our costs and speed your documents to you.  If you are able to receive the document in electronic form via email, no envelope is necessary.)