LAWFUL PRESENCE AFFIDAVIT FOR                                         
                    APPLICANTS APPLYING AS A SOLE PROPRIETOR 
                                        
Pursuant to State of Colorado House Bill 06-1023, all persons eighteen years of age or older shall 
provide proof that they are lawfully present in the United States prior to receipt of certain public 
benefits which include any grant, contract, loan, professional license, or commercial license provided 
by an agency of State or local government or by appropriated funds of a State of local government. 
 
I, ________________________________________________, swear or affirm under penalty or 
perjury under the laws of the State of Colorado that (check one): 
 
____ I am a United States citizen. 
 
____ I am not a United States citizen but I am a Permanent Resident of the United States. 
 
____ I am not a United States citizen but I am lawfully present in the United States pursuant to              
 Federal Law. 
 
____ I am a foreign national not physically present in the United States. 
 
I understand that this sworn statement is required by law because I have applied for a public benefit.  I 
understand that state law required 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. 
 
____________________________                             _____________________________
Signature        Date 
____________________________ 
Printed Name 
 
If this affidavit is not presented in person, applicant must submit a notarized copy of this 
affidavit along with a copy of one of the following forms of authorized identification: 
  1. A valid (current) Colorado’s Driver’s License or a Colorado identification card, or 
  2. United States Military Card or Military dependent’s identification card, or 
  3. United States Coast Guard Merchant Mariner card, or 
  4. Native American Tribal document. 
 
Notarized this ________ Day of ___________________ in the State of ____________________,  
County of _________________________, City of _____________________________________.  
 
_____________________________                            _____________________________
Notary Signature                                         Commission Expires 

Appeared In Person _____                                                      Receipted By _____