Exhibit H SAVE Affidavit.pdf
PDF 90 KB Posted
- Attached to
- Sylvan Road North Sidewalk
- Solicitation number
- ITB 2026-1898
- Issued by
- Fulton County, Georgia
About this file
This document is a Contractor's S.A.V.E. (Systematic Alien Verification for Entitlements) Affidavit for the City of East Point, Georgia, pursuant to O.C.G.A. §50-36-1(e)(2). The affidavit is a form that requires a contractor or applicant to verify their citizenship or immigration status when applying for a City of East Point contract award or public benefit.
The form requires the applicant to check one of three status options: 1) United States citizen, 2) legal permanent resident 18 years or older, or 3) qualified alien or non-immigrant lawfully present in the United States. The applicant must provide at least one secure and verifiable document and potentially an Alien Registration Number. The document includes a warning that knowingly making false statements is a criminal offense under O.C.G.A. §16-10-20, with potential criminal penalties. The form requires the applicant's signature, printed name, and notarization.
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Text version
Exhibit "H" Contractor’s S.A.V.E. Affidavit
Under the Systematic Alien Verification for Entitlements Program Pursuant to O.C.G.A §50-36-1(e)(2)
By executing this affidavit under oath, as an applicant for a City of East Point Georgia contract award or other Public Benefit as provided by O.C.G.A. §50-36-1, and determined by the Attorney General of Georgia in accordance therewith, I am hereby stating the following with respect to my application for a City of East Point contract award/ public benefit:
Name of natural person applying on behalf of individual, business, corporation, partnership, joint venture, or private entity: ___________________________________________________________________.
Check one:
____ 1) I am a United States citizen; or
____ 2) I am a legal permanent resident eighteen (18) years of age or older; or
_____3) I am an otherwise qualified alien or non-immigrant under the Federal Immigration and Nationality Act, who is eighteen (18) years of age or older, and lawfully present in the United States of America. All non-citizens MUST provide their Alien Registration Number here: _________________________.
The undersigned applicant also hereby verifies that he or she has provided at least one (1) secure and verifiable document, as required by O.C.G.A. §50-36-1(e)(1), with this affidavit.
The secure and verifiable document provided with this affidavit is:
In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. §16-10-20, and face criminal penalties as allowed by such criminal statute.
Signature of Applicant
Printed Name of Applicant
Subscribed and sworn before me on this the ___ day of ____________, 202__.
Notary Public (sign and impress seal)
My Commission Expires On:
| Contractor’s S.A.V.E. Affidavit |
| The secure and verifiable document provided with this affidavit is: |
File details come from the government source that posted it. Updated .