Fillable Printable Citizenship Affidavit Form - Alabama

Citizenship Affidavit Form - Alabama

ALABAMA BOARD OF ARCH ITE CT S

77 0 WASHINGTON AVENUE , SUITE 150

MONTGOMERY, AL ABAMA 36 1 3 0 -4450

www.boa.alabama.gov (334) 242-4179

CITI ZENS HIP AFFI DAVIT

APPLICANT’S FULL NAME:

NCARB FILE NUMBER: NCARB CERTIFICATE NUMBERLIDSSOLFDEOH:

FIRM NAME:

BUSINESS

ADDRESS STREET:

CITY: STATE: ZIP:

_________________________________________________________________________________________________

STREET:

RESIDENCE

ADDRESS CITY: STATE: ZIP:

_________________________________________________________________________________________________

DATE OF BIRTH:

SOCIAL SECURITY NUMBER:

DAYTIME TELEPHONE:

E-MA IL AD DRES S:

_________________________________________________________________________________________________

The Beason-Hammon Alabama Taxpayer and Citizen Protection Act of 2011 (Immigration Act) modified by Act 2012-491,

is codified as Title 31, Chapter 13 of the Code of Alabama 1975. The Act requires in Sections 7 and 30 that persons who

receive a professional license from a Board or Commission to demonstrate that they are either United States citizens or

legally present in the United States. Please attach supporting do cumentation th at will verify your citizenship status.

I am a United States citizen (documentation attached).

I am an alien who is legally present in the United States (documentation attach ed).

I am an alien outside the United States who is legally authorized to do business in the United States

(documentation attached).

I understand that this statement is required by law. I understand that making a false statement to the above questions

may subject me to disciplinary action under the laws of the State of Alabama.

________________________________________________ _______________________________________

Signature of Applicant Date

The Beason-Hammon Alabama Taxpayer and Citizen Protection Act of 2011 (Immigration Act) modified by Act 2012-491,

is codified as Title 31, Chapter 13 of the Code of Alabama 1975. The act requires in Sections 7 and 30 that persons who

receive a professional license from a Board or Commission to demonstrate that they are either United States citizens or

legally present in the United States.

UNITED STATES CITIZENSHIP may be demonstrated or confirmed by providing a copy of any one of the following

documents:

• Driver’s license or non-driver’s identification card issued by the Alabama Department of Public Safety or equivalent

governmental agency of another state within the United States, provided that the governmental agency of another

state within the United States requires proof of lawful presence in the United States as a condition of issuance of the

driver’s license or non-driver’s identification card

• Birth certificate indicating birth in the United States or one of its territories

• Pertinent pages of a United States passport (valid or expired) identifying the person and the person’s passport

number, or the person’s United States passport

• United States naturalization documents

• Other documents or methods of proof of United States citizenship issued by the federal government pursuant to the

Immigration and Nationality Act of 1952, as amended

• Bureau of Indian Affairs card number, tribal treaty card number, or tribal enrollment number

• Consular report of birth abroad of a citizen of the United States of America

• Certif ic ate of citizens h ip iss ued b y the Uni ted St ates C i tizens h ip and Immigrat ion Ser vic es

• Certificate of report of birth issued by the United States Department of States

• American Indian card, with KIC classification, issued by the United States Department of Homeland Security

• Final adoption decree showing the person’s name and United States birthplace

• Official United States military record of service showing the applicant’s place of birth in the United States

• Extract from a United States hospital record of birth created at the time of the person’s birth indicating the place of

birth in the United States

• AL-verify

• Valid Uniformed Services Privileges and Identif icati on C ard

• Any other form of identification that the Alabama Department of Revenue authorizes, through an administrative rule

promulgated pursuant to the Alabama Administrative Procedure Act, to be used to demonstrate or confirm a

person’s United States citizenship or lawful presence in the United States, provided that the identification requires

proof of lawful presence in the United States as a condition of issuance.

LAWFUL PRESENCE IN THE UNITED STATES may be demonstrated or confirmed by providing a copy of any one of

the following documents:

• Valid, unexpired Alabama driver’s license

• Valid, unexpired Alabama non-driver identification card

• Valid tribal enrollment card or other form of tribal identification bearing a photograph or other biometric identifier

• Valid United States federal or state government issued identification document bearing a photograph or other

biometric identifier, including a valid Uniformed Services Privileges and Identification Card if issued by an entity that

requires proof of lawful presence in the United States before issuance.

• Foreign passport with an unexpired United States Visa and a corresponding stamp or notation by the United States

Department of Homeland Security indicating the bearer’s admission to the United States

• Foreign passport issued by a Visa waiver country with the corresponding entry stamp and unexpired duration of stay

annotation or an I-94W form by the United States Department of Homeland Security indicating the bearer’s

admission to the United States.