Fillable Printable Citizenship Affidavit Form - Alabama
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 NUMBERLIDSSOLFDEOH:
FIRM NAME:
BUSINESS
ADDRESSSTREET:
CITY:STATE:ZIP:
_________________________________________________________________________________________________
STREET:
RESIDENCE
ADDRESSCITY: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 byAct 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 orCommission to demonstrate that theyare either United States citizens or
legally present in the United States. Please attach supporting do cumentation th at willverify your citizenshipstatus.
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 legallyauthorized 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 disciplinaryaction under the laws of the State of Alabama.
_______________________________________________________________________________________
Signature of ApplicantDate
The Beason-Hammon Alabama Taxpayer and Citizen Protection Act of 2011 (Immigration Act) modified byAct 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 orCommission to demonstrate that theyare either United States citizens or
legally present in the United States.
UNITED STATESCITIZENSHIPmaybe demonstrated or confirmed by providing a copy of anyoneof 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 bythe 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 STATESmaybe demonstrated or confirmed by providing a copy of any oneof
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.
