Statement of Citizenship, Alienage
Page 1 of 10
and Immigration Status
STATEMENT OF CITIZENSHIP, ALIENAGE, AND IMMIGRATION STATUS FOR
STATE PUBLIC BENEFITS
Print Name of Applicant (the applicant is the person who wants to receive a
California Housing Finance Agency (CalHFA) Homeownership Program loan or to
occupy a Multifamily Program unit):
Print Name of Person Acting for Applicant, if any:
*Relationship to Applicant
STATE PUBLIC BENEFITS TO CITIZENS AND ALIENS
Citizens and other nationals of the United States who meet all eligibility requirements may receive a CalHFA
Homeownership Program loan or occupancy of a Multifamily Program unit and must complete Sections A and D of
Aliens who meet all eligibility requirements may receive a CalHFA Homeownership Program loan or occupancy of
a Multifamily Program unit and must complete Sections B, C (if applicable) and D of this form.
SECTION A: CITIZENSHIP STATUS DECLARATION
Is the applicant a citizen or other national of the United States? Yes
To establish citizenship or nationality, please submit one of the documents on List A (attached hereto)
which is legible and unaltered to establish proof.
IF YOU ARE A CITIZEN OR OTHER NATIONAL OF THE UNITED STATES, GO DIRECTLY TO
SECTION D. IF YOU ARE AN ALIEN, PLEASE COMPLETE SECTION B, IF NECESSARY SECTION
C, AND SECTION D.
SECTION B: ALIEN STATUS DECLARATION
IMPORTANT: Please indicate the applicant’s alien status below, and submit original and unexpired documents
evidencing such status. The alien status documents listed for each category are the most commonly used documents
that the United States Immigration and Naturalization Service (INS) provides to aliens in those categories. The
applicant can provide other acceptable evidence of his or her alien status even if not listed below.
An alien lawfully admitted for permanent residence under the Immigration and
Naturalization Act (INA). Evide