Exhibit 2 - AffidavitofLawfulPresence.pdf
PDF 114 KB Posted
- Attached to
- SE Poplar Bluff Building Rehabilitation
- Solicitation number
- 300000170707393
- Issued by
- Missouri
About this file
This document is an Affidavit of Lawful Presence form required by the Missouri Highways and Transportation Commission (MHTC), acting through the Missouri Department of Transportation (MoDOT), for sole proprietors or partners applying for public benefits including grants, contracts, and loans. The affidavit must be completed and notarized separately for each owner and general partner. Applicants are required to certify their lawful presence in the United States by affirming their status as either a United States citizen or an alien lawfully admitted for permanent residence, as mandated by Section 208.009, RSMo.
The affidavit includes acknowledgment of Missouri's penalties for fraudulent misrepresentation in obtaining public benefits, which range from Class C felony charges (for stolen benefits valued between $500 and $25,000, punishable by up to 7 years imprisonment and/or fines up to $5,000) to Class B felony charges (for stolen benefits valued at $25,000 or more, punishable by 5 to 15 years imprisonment). Applicants who submit the sworn affidavit are eligible only for temporary public benefits until lawful presence is verified. MHTC/MoDOT is required by law to provide assistance in obtaining appropriate documentation to prove citizenship or lawful presence, and applicants must submit such requests in writing. The affidavit must be signed before a notary public by the applicant and includes fields for the affiant's signature, Social Security number or applicable federal identification number, and the notary's commission expiration date.
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Text version
EXHIBIT 2
AFFIDAVIT OF LAWFUL PRESENCE FOR SOLE-PROPRIETORSHIP 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 of lawful presence in the United States of America:
I am the of , which is applying for a public benefit owner or partner business 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 .