1108 City Park Ave, Suite 200 Columbus, OH 43206 (614) 224-8374 (877) 224-8374 (614) 224-4514 (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.).
