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O.C.G.A. §50-36-1(e)(2) Affidavit
By executing this affidavit under oath, as an applicant for a(n)
LLC, Corporation, Sole Proprietorship , etc.
as referenced in O.C.G.A §50-36-1, from the Greene County Board of Commissioners, the undersigned applicant verifies one of the following with respect to my application for a public benefit:
The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. §50-36-1(e)(1), with this affidavit.
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 O.C.G.A. §16- 10-20, and face criminal penalties allowed by such statute.
Executed on the______ day of ___________________, 20____ in,___________________________________
___________________________________________________________________Signature of Authorized Officer or Agent
___________________________________________________________________Printed Name of and Title of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME ON THIS THE _______ DAY OF _______________________, 20________
___________________________________________________________________My Commission Expires
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