City of Sheridan, Colorado 
  4101 S. Federal Blvd. 
  Sheridan, CO 80110-5399 
                                    
  LAWFUL PRESENCE AFFIDAVIT 
                                    
I, _____________________________________, 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 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. 
 
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Signature      Date