Business Registration And Retail Sales Tax Application For: 2009

Business Registration And Retail Sales Tax Application For: 2009 - City Of Glendale Page 4

____________________________________________________________________________________________________________

LAWFUL PRESENCE AFFIDAVIT

(this form only needs to be filled out by applicants who are applying as a sole proprietor)

swear or affirm under penalty of perjury under the laws of the

State of Colorado that (check one):

____ I am a United States citizen, or

____ I am a legal Permanent Resident of the United States, or

____ I am otherwise 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 18-8503

and it shall constitute a separate criminal offense each time a public benefit is fraudulently received.

Signature

Date

Per HB 06S-1023, you must provide a copy of one of the following IDs.

! Colorado Driver’s License

! Colorado ID card

! Military IDs

! Coast Guard mariner document

! Native American tribal document

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Business Registration And Retail Sales Tax Application For: 2009 - City Of Glendale Page 4