Statement of citizenship, alienage and immigration status - California ... 2025

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The document is a form from the California Department of Business Oversight that requires applicants for licenses or certificates to declare their citizenship, alienage, and immigration status. It outlines the necessary sections to be completed by U.S. citizens and aliens, detailing the required documentation for each status category. The form includes declarations regarding battered aliens and provides guidelines for establishing U.S. citizenship through various means, including primary and secondary evidence. Additionally, it emphasizes the importance of providing accurate personal information and outlines privacy practices related to the collection of this information.

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Click ‘Get Form’ to open it in the editor.
Begin with Section A: Citizenship/Immigration Status Declaration. Indicate if you are a citizen or national of the United States by selecting 'Yes' or 'No'. If 'Yes', provide your place of birth.
If you are a citizen, proceed directly to Section D. If you are an alien, complete Section B by indicating your alien status and providing the necessary documentation as outlined.
In Section C, if applicable, declare any history of being battered or subjected to extreme cruelty. Provide evidence as required.
Finally, in Section D, sign and date the form under penalty of perjury, confirming that all information provided is true and correct.

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What is a statement of citizenship form?

STATEMENT OF CITIZENSHIP, ALIENAGE, AND IMMIGRATION STATUS Evidence of the U.S. citizenship of the parents and the relationship of the applicant to the parents, and evidence that at least one parent residing in the U.S. or an outlying possession prior to the applicants birth.

How to answer citizenship status?

1. Are you a United States (US) citizen by birth, or were you born abroad to parents of whom at least one was a US citizen at the time of your birth, or are you a US National? If Yes, check the box marked US Citizen.

What is a proof of immigration status?

Permanent Resident Card, Green Card (I-551). Employment Authorization and Advance Parole Card (I-512) (authorization for parole, indicating T-2, T-3, T-4, T-5,status). T-Visa Application (I-914). Certification status verified through U.S. Department of Health and Human Services.

What is proof of citizenship in California?

Primary (Stand-Alone) Evidence of Citizenship U.S. Passport or U.S. Passport Card, current or expired (issued without limitation). Certificate of U.S. Citizenship.

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