United States Citizenship Attestation Form For the purpose of complying with Neb. Rev. Stat. §§ 4-108 through 4-114, I attest as follows: I am a citizen of the United States. -- OR -- I am a qualified alien under the federal Immigration and Nationality Act, my immigration status and alien number are as follows: __________________________________, and I agree to provide a copy of my USCIS documentation upon request. I hereby attest that my response and the information provided on this form and any related application for public benefits are true, complete, and accurate and I understand that this information may be used to verify my lawful presence in the United States. PRINT NAME _________________________________________________________ (first, middle, last) SIGNATURE _________________________________________________________ DATE _________________________________________________________ 1/19/2010 American LegalNet, Inc. www.FormsWorkFlow.com