Looking for a California Legal Forms And Templates? Download it for free!

Form 250.61 - Statement Of Citizenship, Alienage, And Immigration Status For Application Of Department Of Corporations License Or Certificate Page 3

An alien paroled into the United States for at least one year under

[ ]

Section 212(d)(5) of the INA. Evidence includes:

•

INS Form I-94 with stamp showing admission for at least one

year under Section 212(d)(5) of the INA.

(Applicant cannot aggregate periods of admission for less than

one year to meet the one-year requirement.)

An alien paroled into the United States for less than one year under

[ ]

Section 212(d)(5) of the INA. (Evidence includes INS Form I-94 showing this

status.)

An alien not in status categories 1 through 8 who has been admitted to

[ ]

the United States for a limited period of time (a non-immigrant). Non-immigrants

are persons who have temporary status for a specific purpose. (Evidence

includes INS Form I-94 showing this status.)

SECTION C: DECLARATION FOR BATTERED ALIENS

IMPORTANT: Complete this section if the applicant, the applicant's child or the applicant

child's parent has been battered or subjected to extreme cruelty in the United States.

Has the INS or the EOIR granted a petition or application filed by or on behalf

[ ]

of the applicant, the applicant's child, or the applicant's child's parent under the

INA or found that a pending petition sets forth a prima facie case? Evidence

includes one of the documents on List B (attached hereto).

Has the applicant, the applicant's child, or the applicant child's parent

[ ]

been battered or subjected to extreme cruelty in the United States by a spouse

or parent, or by a spouse's or parent's family member living in the same house

(where the spouse or parent consented to, or acquiesced in the battery or

cruelty)?

SECTION D:

I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF

CALIFORNIA THAT THE ANSWERS I HAVE GIVEN ARE TRUE AND CORRECT TO THE

BEST OF MY KNOWLEDGE.

Applicant's Signature: ____________________________ Date: ______

Signature of Person

Acting For Applicant: _____________________________ Date: ______

Form 250.61 - Statement Of Citizenship, Alienage, And Immigration Status For Application Of Department Of Corporations License Or Certificate Page 3