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Form Ftb 9225 C-1 - Declaration Of Citizenship, Alienage, And Immigration Status For Homeowner And Renter Assistance

STATE OF CALIFORNIA

FRANCHISE TAX BOARD

HOMEOWNER AND RENTER ASSISTANCE PROGRAM

PO BOX 942886

SACRAMENTO CA 94286-0940

TELEPHONE: (800) 868-4171

DECLARATION OF CITIZENSHIP, ALIENAGE, AND IMMIGRATION STATUS FOR

HOMEOWNER AND RENTER ASSISTANCE

FIRST NAME

MIDDLE INITIAL

LAST NAME

SOCIAL SECURITY NUMBER

Citizens of the United States who meet all eligibility requirements may receive homeowner or renter

assistance. To receive assistance, you must complete Sections A and C.

California residents who are not citizens, but meet all eligibility requirements may receive homeowner

or renter assistance. To receive assistance, you must complete Sections A, B, and C.

NOTE: In this document we refer to the Immigration and Nationality Act as INA.

SECTION A: CITIZENSHIP DECLARATION

1. Are you a United States citizen?

Yes

If you checked “Yes”, go to Section C. If you checked “No” and you meet all eligibility requirements,

please complete Sections B and C.

SECTION B: ALIEN STATUS DECLARATION

General Information

If you are a California resident, but not a United States citizen, you may file a claim for homeowner or

renter assistance if you meet the income, age, blindness, or disability requirements for assistance

and are one of the following:

• A qualified alien

• A nonimmigrant alien under the INA or

• An alien paroled into the United States under Section 212(d)(5) of the INA for less than one year

We describe these categories of aliens further in the code chart that follows. Undocumented aliens

and aliens not described in the code chart are not eligible to receive homeowner or renter assistance.

Instructions

If you are a California resident, but not a United States citizen, please provide your alien registration

number and date of entry below. Next, find the category listed on the following Eligibility Code Chart

For Noncitizens (See Side 2) that accurately describes your presence or admission to the United

States. Find the alien status code letter for your category and enter it below.

ALIEN REGISTRATION NUMBER

DATE OF ENTRY

ALIEN STATUS CODE

FTB 9225 C-1 (REV 08-2004) SIDE 1

Form Ftb 9225 C-1 - Declaration Of Citizenship, Alienage, And Immigration Status For Homeowner And Renter Assistance