Cobb County Business License Division 1 New Alcoholic Beverage ...
Cobb County Business License Division 1 New Alcoholic Beverage ...
Cobb County Business License Division 1 New Alcoholic Beverage ...
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<strong>Cobb</strong> <strong>County</strong> <strong>Business</strong> <strong>License</strong> <strong>Division</strong><strong>New</strong> <strong>Alcoholic</strong> <strong>Beverage</strong> Establishment ApplicationRevised 1/09 39Affidavit 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 statingthe following with respect to my application for a <strong>Cobb</strong> <strong>County</strong> <strong>Business</strong> <strong>License</strong> for_________________________________[INSERT BUSINESS NAME]:_______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 18years of age or older and lawfully present in the United States.In making the above representation under oath, I understand that any person who knowingly andwillfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of aviolation of Code Section 16-10-20 of the Official 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_____________________________