Fillable United States Citizenship Attestation Form (Nebraska)

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United States Citizenship Attestation Form (Nebraska)

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Country of origin: US
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Revised 7/2012
United States Citizenship Attestation Form
For the purpose of complying with Neb. Rev. Stat. §§ 4-108 through 4-114, I attest as
follows:
I am a citizen of the United States.
— OR —
I am a qualified alien under the federal Immigration and Nationality Act. In addition to
this Form, I have included a current and legible copy of the front and back of one or
more of the available USCIS forms, (listed below), required for verification.
I-327 (Reentry Permit)
I-551 (Permanent Resident Card)
I-571 (Refugee Travel Document)
I-766 (Employment Authorization Card)
Certificate of Citizenship
Naturalization Certificate
Machine Readable Immigrant Visa (with Temporary I-551 Language)
Temporary I-551 Stamp (on passport or I-94)
I-94 (Arrival/Departure Record)
Unexpired Foreign Passport (must include an I-94)
I-20 (Certificate of Eligibility for Nonimmigrant (F-1) Student Status
DS2019 (Certificate of Eligibility for Exchange Visitor (J-1) Status
I hereby attest that my response and the information provided on this form and any
related application for public benefits are true, complete, and accurate and I
understand that this information may be used to verify my lawful presence in the
United States.
Print Name ____________________________________________________________
(First, Middle, Last)
Signature _____________________________________________________________
Individual NMLS ID # _______________________ Date ______________________
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United States Citizenship Attestation Form (Nebraska)

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Completed 13 March 2022

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