Denver Sales Tax Special Event Application / Registration - Treasury Division, Affidavit - Denver Treasury Divison Page 4
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5CITY AND COUNTY OF DENVER
DEPARTMENT OF REVENUE
TREASURY DIVISON
McNICHOLS CIVIC CENTER BUILDING
JOHN W. HICKENLOOPER
MAYOR
144 WEST COLFAX AVENUE
DENVER, COLORADO 80202
FAX: (720) 865-7081
AFFIDAVIT
For the City and County of Denver as Proof of Lawful Presence
in the United States
I, _________________________________, Applicant, swear or affirm under
penalty of perjury under the laws of the State of Colorado the following:
1.
I am over eighteen years of age and am competent to make this Affidavit.
2.
I swear or affirm that (check one):
_____ I am a United States citizen, or
_____ I am a legal permanent resident of the United States, or
_____ I am an alien lawfully present in the United States pursuant to
Federal law.
3.
I understand that this sworn statement is required by law because I have
applied for a commercial license. 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 Statutes §§18-8-501 and 18-8-
503 and it shall constitute a separate criminal offense each time a commercial license is
fraudulently received.
__________________________________
Signature of Applicant
DATE: __________________, 200__
DATE: __________________, 200__
STATE OF _____________ )
)ss.
COUNTY OF _________
)
The foregoing Affidavit was acknowledged before me in person by ______________
this __________ day of ___________, 200___, and an acceptable form of identification
under the list attached to this affidavit was produced to me.
A copy of the acceptable
form of identification which I reviewed in order to provide this notary identification is
attached to this affidavit.
Witness my hand and official seal.
My commission expires: ________________.
_______________________________
Notary Public
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