Application For Luther House Apartment Template Page 9
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14If you checked the above block and you are 62 years of age or older and receiving
assistance on June 19, 1995, you should submit a proof of age document, together with
this format, and sign here:
______________________________________________
__________________
Signature
Date
OR
If you checked the above block and you are under 62 years of age, you must submit the
following documents:
a. Verification Consent Format /AND/
b. One of the following documents:
(1) Form I-551, Alien Registration Receipt Card (for permanent
resident aliens);
(2) Form I-94, Arrival-Departure Record, with one of the
following annotations:
(i)
“Admitted as Refugee Pursuant to section 207”;
(ii)
“Section 208” or “Asylum”
(iii)
“Section 243 (h)” or “Deportation stayed by
Attorney General”;
(iv)
“Paroled pursuant to Section 212 (d)(5) of the INA”
(3) If Form I-94, Arrival-Departure Record, is not annotated, then
accompanied by one of the following documents:
(i)
A final court decision granting asylum (but only if
no appeal is taken);
(ii)
A letter from an INS asylum officer granting
asylum (if application is filed on or after October 1,
1990) or from an INS district director granting
asylum (if application filed before October 1, 1990);
(iii)
A court decision granting withholding of
deportation; or
(iv)
A letter from an INS asylum officer granting
withholding of deportation (if application filed on
or after October 1, 1990)
(4) Form I-688, Temporary Resident Card, which must be
annotated “section 245A” or “section 210”;
(5) Form I-688 B, Employment Authorization Card, which must
be annotated “Provision of Law 274a.12 (11)” or “Provision
of Law 274a.12”;
(6) A receipt issued by the INS indicating that an application for
issuance of a replacement document in one of the above-listed
categories has been made and the applicant’s entitlement to the
document has been verified.
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