Fillable Form 2019: NOTARIZED PROOF OF CITIZENSHIP (University of Pittsburgh at Johnstown)

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Form 2019: NOTARIZED PROOF OF CITIZENSHIP (University of Pittsburgh at Johnstown)

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2019
–
2020
NOTARIZED PROOF OF CITIZENSHIP
Student Name:__________________________________________ Student ID Number:___________________
E-mail address:__________________________________________ Phone Number:_______________________
Section 1: To be lled out by student
I ___________________________________ hereby swear (or arm) that the attached* reproduction of the
Student Name
___________________________________ is a true, correct and complete photocopy of a document in my
Document Type
possession, which contains ______ page(s).
______________________________________________
Student Signature
FORM ID: F20CTZ REV:10.25.18
Section 2: To be lled out by Notary
Subscribed and sworn to (or armed) before me on this ______ day of __________________, _______ by
Month Year
_____________________________, proved to me on the basis of satisfactory evidence to be the person(s)
Student Name
who appeared before me.
______________________________________________
Notary Signature Seal
*THE REGISTERED NOTARY MUST ATTACH A COPY OF THE FRONT AND BACK OF THE
CITIZENSHIP DOCUMENT TO THIS STATEMENT AFTER IT HAS BEEN VIEWED IN PERSON.
Oce of Financial Aid
450 Schoolhouse Road
Johnstown, PA 15904
Phone: 814-269-7045
Phone: 800-881-5544
Fax: 814-269-7061
Email: upjaid@pitt.edu
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Form 2019: NOTARIZED PROOF OF CITIZENSHIP (University of Pittsburgh at Johnstown)

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Completed 30 August 2020

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