Form Crf-009 - State Alcohol License Application - 2011 Page 3
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CRF-009 (Rev. 6/11)
Affidavit of Compliance with O.C.G.A. 50-36-1 “Verification of Lawful Presence within the United States”
O.C.G.A. 50-36-1 requires that applicants applying for such things as licenses for public benefits complete a signed
and sworn affidavit verifying the applicant’s lawful presence in the United States. Therefore, the applicant must
answer the following questions:
The applicant is a United States citizen or legal permanent resident at least eighteen (18) years old.
Yes ______ No ______
The applicant is a qualified alien or nonimmigrant under the federal Immigration and Nationality Act, Title 8
U.S.C., as amended, at least eighteen (18) years old, and is lawfully present in the United States. The applicant’s
alien number issued by the Department of Homeland Security or other federal immigration agency must be
provided.
Yes ______
No ______
Alien Number ____________________________________
O.C.G.A 50-36-1 states that “Any person who knowingly and willfully makes a false, fictitious, or fraudulent
statement of representation in an affidavit executed pursuant to this Code section shall be guilty of a violation of
Code Section 16-10-20.”
I declare, under penalty of law, that this affidavit has been completed by me and is true and correct.
___________________________________________________________________________________________
Signature
Title
Date
(Must be signed by applicant. If the applicant is a corporation, must be signed by an officer of the corporation.
STAMPED SIGNATURE IS NOT ACCEPTABLE)
I hereby certify that__________________________________________________________ is personally known, or
verified by me, that the applicant signed this application after stating to me his or her personal knowledge and
understanding of all statements and, under oath actually administered by me, has sworn that the statements and
answers contained in this affidavit are true.
This _________ day of _____________, ______ .
_______________________________________
Notary Public
AFFIX SEAL
You must attach a copy of a secure and verifiable document as defined in O.C.G.A. 50-36-2. Such documents
include a valid Georgia issued Driver's License or ID Card, a valid Driver's License issued by another State or an
identification document issued by the United States Government.
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