HomeMy Public PortalAbouttybee affidavit.pdfO.C.G.A. § 50-36-1(e)(2) Affidavit
By executing this affidavit under oath, as an applicant for a(n) Indigent Defense Services
contract for a public benefit as referenced in O.C.G.A. § 50-36-1, from the City of Tybee,
the undersigned applicant verifies one of the following with respect to my application for
a public benefit:
1) x I am a United States citizen.
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 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 O.C.G.A.
§ 50-36-1(e)(1), with this affidavit.
The secure and verifiable document provided with this affidavit can best be classified as:
Driver's License
In making the above representation under oath, I . understand that any person who
knowingly and willfully makes a false, fictitious, or fraudulent statement or
representation in an 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.
Executed in Anna (city), Carer. -61 (state).
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Printed Name of Applicant
SUBSCRIBED AND SWORN
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