Example: air traffic controller
Exhibit 3-5: **Sample Citizenship Declaration

Exhibit 3-5: **Sample Citizenship Declaration

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RELATIONSHIP TO DATE OF HEAD OF HOUSEHOLD SEX BIRTH _____ SOCIAL ALIEN SECURITY NO. REGISTRATION NO. ADMISSION NUMBER_____if applicable (this is an 11-digit number found on DHS Form I-94, Departure Record) NATIONALITY (Enter the foreign nation or country

  Birth, Date, Country, Nationality

Download Exhibit 3-5: **Sample Citizenship Declaration


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