NORCROSS SAVE Affidavit.pdf
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- Solicitation number
- PE-66780-NONST-2026-000000038
- Issued by
- Gwinnett County, Georgia
About this file
This is a SAVE (Security and Immigration Compliance) Public Benefit Affidavit form issued by the City of Norcross, Georgia, in compliance with the Georgia Security and Immigration Compliance Act of 2006 (O.C.G.A. 50-36-1). The affidavit is required for all applicants seeking public benefits from the city, including occupational tax licenses, alcoholic beverage licenses, contracts, bid packets, and other applicable documents. Applicants must execute the sworn affidavit before a notary public and return it with their associated application or bid submission. The form requires applicants to verify their lawful presence in the United States by selecting one of three options: U.S. citizenship, legal permanent resident status, or qualified alien or non-immigrant status under federal immigration law with a valid alien number issued by the Department of Homeland Security.
Applicants must verify they are 18 years of age or older and submit at least one secure and verifiable document as required by Georgia law, with the specific document type identified at the time of submission. The affidavit carries significant legal consequences; applicants acknowledge that knowingly making false, fictitious, or fraudulent statements constitutes a violation of O.C.G.A. 16-10-20 and subjects them to criminal penalties. The notary public must complete the attestation section, including execution date and commission expiration date. All submissions should be directed to the City of Norcross at 65 Lawrenceville Street, Norcross, Georgia 30071, by phone at 770.448.2122 or fax at 770.448.5945.
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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 .