Citizenship Attestation2

1108 City Park Ave, Suite 200
Columbus, OH 43206
[phone]
[phone]
[phone] (Fax)
Formerly Legal Aid Society of Columbus www.lasco.org
Citizenship Attestation
Our funding sources require us to obtain certain information from clients. One of the
items we need is a signed statement of citizenship status.
Thank you very much for your cooperation in this matter
PLEASE SIGN THE STATEMENT THAT APPLIES TO YOU
I am a citizen of the United States:
________________________________ _____________
Signature of Applicant Date
(Print Name)
I am NOT a citizen of the United States:
________________________________ _____________
Signature of Applicant Date
(Print Name)
**If you are not a citizen, please provide us with a copy of your resident status
information (green card,
I-94, etc.).
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