Because of Colorado House Bill 06S-1023 (C.R.S. 24-76.5-103), this affidavit is MANDATORY and must be submitted along wit h a copy of one of accepted forms of identification to prove lawful presence in the United States. Colorado law now requires that the City Brighton verify all natural persons 18 years or older or sole proprietors who are applying for a public benefit are lawfully present in the United States prior to receiving the public benefit. A public benefit includes the application or a renewal of a grant, loan, contract, and professional or commercial licenses provided by an agency of the state or local government.

FOR CORPORATIONS/PARTNERSHIPS/COMPANIES ETC . - ONLY
The applicant, for whom I am authorized to sign, is NOT a “natural person” or “sole proprietorship,” but a corporation, partnership, company or other similar entity. HB 065-1023 is not applicable.

I understand this sworn statement is required because the applicant has applied for a “Public Benefit.” I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the laws of Colorado.

_____________________________________________ _______________________________
Printed Name Applicant/Representative Title

______________________________________________________________ _______________________________
Signature Date

______________________________________________________________________________
Name of Business

OR
FOR “NATURAL PERSONS” OR SOLE PROPRIETORS – ONLY
I am a “natural person” or a “sole proprietorship,” NOT a corporation, partnership, company or other similar entity and MUST complete this affidavit and submit it with the required documentation.

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 this sworn statement is required by law because I have applied for a “Public Benefit.”
I understand state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit.
I acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the laws of Colorado.
I have attached a copy of one of the acceptable documents provided by the State of Colorado and I presented it to the agency as proof of identification that I am at least 18 years of age and I am lawfully in the United States.

_____________________________________________ _______________________________
Printed Name Applicant/Representative Title

______________________________________________________________ _______________________________
Signature Date

______________________________________________________________________________
Name of Business

Forms of identification allowed: CO Driver’s License CO ID Card US Military ID or Dependent’s ID
US Coast Guard Merchant Card Native American Tribal Document

AFFIDAVIT FOR LAWFUL PRESENCE VERIFICATION

License/Permit #________________

1019175 9372600

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