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Affidavit Of Legal Residency

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Colorado Department of Public Safety

Division of Fire Prevention and Control

700 Kipling Street, Suite 4100

Lakewood, CO 80215

(303)239-4100 phone (303)239-4131 fax

cdps_dfpc_suppression@state.co.us

cdps_dfpc_fireworks@state.co.us

AFFIDAVIT OF LEGAL RESIDENCY

I, _____________________________________________________, swear or affirm under penalty of

perjury under the laws of the State of Colorado that (please check one):

I am a United States citizen, or

I am a Permanent Resident of the United States, or

I am lawfully present in the United States pursuant to Federal law

I understand that this sworn statement is required by law because I have applied for a public benefit.

I understand that state law requires me to provide proof that I am lawfully present in the United States prior to

receipt of this public benefit. I further acknowledge that making a false, fictitious, or fraudulent statement or

representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second

degree under Colorado Revised Statute 18-8-503, and it shall constitute a separate

Criminal offense each time a public benefit is fraudulently received.

Verification of Legal Residency

I HAVE ATTACHED A PHOTOCOPY of identification of legal residency to establish lawful presence in the

United States. The following forms of identification are acceptable pursuant to the Colorado Department of Revenue*:

• A valid State driver’s license or a State identification card,

issued pursuant to Article 2 of title 42, C.R.S.; or

• A United States military card or military dependent’s identification

card; or

• A United States Coast Guard Merchant Mariner card; or

• A Native American tribal document



SIGNATURE

DATE

Subscribed and affirmed, or sworn before me in the

County of:

State

Day

Month

Year

of:

My commission expires:

NOTARY STAMP

Notary Public Signature:

Print Form

Please visit the Colorado Department of Revenue web site for additional information and alternative acceptable identification documents:

Colorado Department of Revenue

07/15/15

DFPC

FORM-3007

Affidavit Of Legal Residency

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