CITY OF FLAGSTAFF, ARIZONA
LICENSE ELIGIBILITY FORM
LAWFUL PRESENCE IN THE UNITED STATES
ARS § 41-1080 requires that any individual wishing to be issued a license must demonstrate through the presentation
of one of the following documents demonstrating lawful presence in the United States.
LAWFUL PRESENCE IN THE UNITED STATES CAN BE DEMONSTRATED BY
PRESENTATION OF ONE (1) OF THE DOCUMENTS LISTED BELOW.
Please place a check mark next to the applicable document and attach a copy of the document to this eligibility form.
(If the document says on its face that it may not be copied or you know for reasons of confidentiality that it cannot
be copied, you will need to present the document in person to the City for review and signing of the form.)
1.
A valid driver license. If from Arizona, must be issued after 1996
Print first 4 numbers/letters from license:
2.
A valid non-operating identification License
Print first 4 numbers/letters:
3.
A birth certificate or delayed birth certificate issued in any state, territory or possession of the
United States
Year of birth: Place of birth:
4.
A United States Certificate of Birth abroad
Year of birth: Place of birth:
5.
A United States passport
Print first 4 numbers/letters from Passport:
6.
A foreign passport with a United States Visa
Print first 4 numbers/letters from Passport
Print first 4 numbers/letters from Visa
7.
An I-94 form with a photograph
Print first 4 numbers from I-94:
8.
A United States Citizenship and Immigration Services
Employment Authorization Document (EAD)
Print first 4 numbers/letters from EAD:
9.
Refugee travel document
Date of Issuance: _Refugee Country:
10.
A United States Certificate of Naturalization
Print first 4 digits of CIS Reg. No.:
11.
A United States Certificate of Citizenship
Date of Issuance: Place of Issuance:
12.
A tribal Certificate of Indian Blood
Date of Issuance: Name of Tribe:
13.
A tribal or Bureau of Indian Affairs Affidavit of Birth
Year of Birth: Place of Birth:
14.
Any other license that is issued by the federal government, any other state government, an agency
of this state or a political subdivision of this state that requires proof of citizenship or lawful alien
status.
In accordance with the requirements of State Law, I do swear or affirm under penalty of perjury that I am lawfully
present in the United States and that the document I presented to establish this presence is true.
Signature Business/Company
Print Name Business Address
Date City, State, Zip Code