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UPDATED: NOVEMBER 2009

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DOCUMENTS ESTABLISHING U.S. CITIZENSHIP AND IDENTITY continued Ver: 11/19/07

FOURTH LEVEL DOCUMENTS (continued) Fourth Level Documents continued Explanation: Satisfactory reliability when a primary, secondary or third level document is not available; should be used only in the rarest of circumstances; also requires an identity document. Institutional admission papers from a nursing facility, skilled care facility or other institution (created at least 5-years before the application date) showing a U.S. place of birth Admission records generally show biographical information for the person including place of birth; the record can be used to establish U.S. citizenship when it shows a U.S. place of birth.

Written Affidavit Affidavits should ONLY be used in rare circumstances. The affidavit must contain the following information under the following circumstances: • There must be at least two affidavits by two individuals who have personal knowledge of the event(s) establishing the applicant’s or recipient’s claim of citizenship. • The two affidavits can be combined in a joint affidavit. • At least one of the individuals making the affidavit cannot be related to the applicant or recipient. • The person(s) making the affidavit must be able to provide proof of his or her own citizenship and identity for the affidavit to be accepted. • The affidavit must also be signed under penalty of perjury by the person making the affidavit, but need not be notarized. • A separate affidavit from the applicant/recipient or other knowledgeable individual (guardian or representative) explaining why documentary evidence does not exist or cannot be readily obtained must also be obtained.

(MRG)