Bid Document - Exhibit 2 BLANK.pdf
PDF 73 KB Posted
- Attached to
- ECONOLITE PRODUCTS
- Solicitation number
- 300000237993928
- Issued by
- Missouri
About this file
This is an Affidavit of Lawful Presence form required by the Missouri Department of Transportation (MoDOT), acting through the Missouri Highways and Transportation Commission (MHTC), for sole proprietors, individual proprietorships, or partnerships applying for public benefits including grants, contracts, and loans. The affidavit requires each owner and general partner to separately certify their lawful presence in the United States by attesting to either U.S. citizenship or status as an alien lawfully admitted for permanent residence. The form must be completed before a notary public and signed by the applicant under oath, with the affiant's signature and applicable federal identification number required.
Applicants who submit the affidavit are eligible only for temporary public benefits until lawful presence is verified in accordance with Missouri Revised Statutes Section 208.009. The document explicitly warns that obtaining public benefits through willfully false statements, concealment of facts, or fraudulent means constitutes a Class C felony (for benefits valued between $500 and $25,000, punishable by up to 7 years imprisonment and/or fines up to $5,000) or a Class B felony (for benefits valued at $25,000 or more, punishable by 5 to 15 years imprisonment). MoDOT/MHTC is required by Missouri law to provide assistance in obtaining appropriate documentation to prove citizenship or lawful presence, with assistance requests to be submitted in writing.
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Text version
Exhibit2
AFFIDAVIT OF LAWFUL PRESENCE FOR SOLE-PROPRIETORSIDP OR PARTNERSHIP
(a separate affidavit is required for each owner and general partner)
) STATE OF -------
) ss
COUNTY OF ______ )
On this day of 20 __ , before me appeared
--------------� personally known to me or proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instruments, who being by me duly sworn, deposed as follows:
My name is --------------� and I am of sound mind, capable of making this affidavit, and personally certify the facts herein stated, as required by Section 208.009, RSMo, for failure to provide affirmative proof oflawful presence in the United States of America:
I am the _______ of ---��--------' which is applying for a public benefit owner or partner busmess name
(grant, contract, and/or loan) administered/provided by the Missouri Highways and Transportation Commission (MHTC), acting by and through the Missouri Department of Transportation (MoDOT).
I am classified by the United States of America as: (check the applicable box)
□ a United States citizen. □ an alien lawfully admitted for permanent residence.
I am aware that Missouri law provides that any person who obtains any public benefit by means of a willfully false statement or representation, or by willful concealment or failure to report any fact or event required to be reported, or by other fraudulent device, shall be guilty of the crime of stealing pursuant to Section 570.030, RSMo, which is a Class C felony for stolen public benefits valued between $500 and $25,000 (punishable by a term of imprisonment not to exceed 7 years and/or a fine not more than $5,000 - Sections 558.011 and 560.011, RSMo), and is a Class B felony for stolen public benefits valued at $25,000 or more (punishable by a term of imprisonment not less than 5 years and not to exceed 15 years
- Section 558.011, RSMo).
I recognize that, upon proper submission of this sworn affidavit, I will only be eligible for temporary public benefits until such time as my lawful presence in the United States is determined, or as otherwise provided by Section
208.009, RSMo.
I understand that Missouri law requires MHTC/MoDOT to provide assistance in obtaining appropriate documentation to prove citizenship or lawful presence in the United States, and I agree to submit any requests for such assistance to MHTC/MoDOT in writing.
I acknowledge that I am signing this affidavit as a free act and deed and not under duress.
Affiant Signature Affiant's Social Security Number or Applicable Federal Identification Number
Subscribed and sworn to before me this ___ day of _______ , 20 __
Notary Public My commission expires:
File details come from the government source that posted it. Updated .