Cobb County Business License Division P.O. Box 649 Marietta ...
Cobb County Business License Division P.O. Box 649 Marietta ...
Cobb County Business License Division P.O. Box 649 Marietta ...
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<strong>Cobb</strong> <strong>County</strong> <strong>Business</strong> <strong>License</strong> <strong>Division</strong> 36Alcoholic Beverage Establishment Change of <strong>License</strong>e ApplicationRevised 1/09Affidavit Verifying StatusOf <strong>Cobb</strong> <strong>County</strong> <strong>Business</strong> <strong>License</strong> ApplicationBy executing this affidavit under oath, as an applicant for a <strong>Cobb</strong> <strong>County</strong> <strong>Business</strong> <strong>License</strong>, I am stating the following withrespect to my application for a <strong>Cobb</strong> <strong>County</strong> <strong>Business</strong> <strong>License</strong> for _________________________________[INSERT BUSINESSNAME]:_______I am a United States citizen or legal permanent resident 18 years of age or older;OR_______I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act 18 years of age or olderand lawfully present in the United States.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 Code Section 16-10-20 of theOfficial Code of Georgia._____________________________Signature of Applicant_____________________________Date_____________________________Printed NameSUBSCRIBED AND SWORNBEFORE ME ON THIS THE____ DAY OF ____________, 20_______________________________Notary PublicMy Commission Expires:__________________________________Alien Registration number for non-citizens_____________________________
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