NORCROSS SAVE Affidavit.pdf
PDF 577 KB Posted
- Attached to
- PINNACLE PARK DREDGING
- Solicitation number
- PE-66780-NONST-2024-000000019
- Issued by
- Gwinnett County, Georgia
About this file
This document is a SAVE Public Benefit Affidavit required by the Georgia Security and Immigration Compliance Act of 2006 for applicants seeking public benefits from the City of Norcross, Georgia. The affidavit requires the applicant to verify their lawful presence in the United States by attesting to their status as a U.S. citizen, legal permanent resident, or qualified alien with a valid alien number. The applicant must also provide at least one secure and verifiable document as proof of identity. Submission of a false statement or representation in this affidavit can result in criminal penalties under Georgia law.
The document outlines the application process and requirements for individuals or businesses seeking public benefits such as an occupational tax license or alcoholic beverage license from the City of Norcross. There are no details provided regarding any specific contract opportunities, product or service requirements, response dates, or award information.
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Text version
Instructions: As required by Georgia Security and Immigration Compliance Act of 2006, as amended, every agency administering or providing Public Benefits is responsible for requiring that applicants for public benefits execute a sworn affidavit verifying the applicant’s lawful presence in the United States (Ga. Code 50-36- 1(f)(2). The applicant shall execute this affidavit in front of a Notary and return it to the city along with the associated application, renewal form, contract, bid packet, or other applicable document.
By executing this affidavit under oath, as an applicant for (Occupational Tax license or Alcoholic Beverage license or any other Public benefit) as referenced in O.C.G.A. § 50-36-1, from the City of Norcross, the undersigned applicant verifies one of the following with respect to my application for public benefit.
(Please check one)
1) I am a United States citizen. (REQUIRES VERIFICATION AT SUBMISSION)
2) I am a legal permanent resident of the United States.
3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency.
My alien number issued by the Department of Homeland Security or other federal immigration agency is: _.
The undersigned applicant has also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by Georgia Law O.C.G.A § 50-36-1(f) (1) A complete list of secure and verifiable documents on back of this form.
REQUIRES VERIFICATION AT SUBMISSION – Which type of secure and verifiable document was provided with this affidavit? .
In making the above representation under oath, I understand that any person who knowingly and willfully who makes a false, fictitious, or fraudulent statement or representation in this 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.
MUST BE COMPLETED BY NOTARY
I, (representative for) (Printed NAME of individual and natural person) (Name of BUSINESS, corporation, partnership, etc.)
Signature of Applicant Date
SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF ,20
Executed in (City), (State)
NOTARY PUBLIC Signature My Commission Expires
65 Lawrenceville St. Norcross, GA 30071 [P] 770.448.2122 [F] 770.448.5945 www. norcrossga.net
SAVE Public Benefit Affidavit
O.C.G.A. § 50-36-1
File details come from the government source that posted it. Updated .