AFFIDAVIT OF LAWFUL PRESENCE

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 that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires 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

For internal use only:

IDENTIFICATION
PROVIDED

___ Colorado Drivers License
___ Colorado Identification Card Issued by
Department of Motor Vehicles
___ United States Military Card
___ United States Military Dependent
Identification Card
___ United States Coast Guard Merchant Mariner Card
___ Native American Tribal Document

For internal use only:

ALTERNATE ID. PROVIDED
Only through July 1, 2010

___ Original birth certificate from any state of the United States
___ Certificate verifying naturalized status by U.S. with photo
       and raised seal
___ certificate verifying U. S. citizenship by U. S. government.
       e.g.. U.S. passport
___ order of adoption by a U. S. court with seal of certification
___ valid driver's license from any state of the U.S. or the Dist.
       of Columbia excluding AK. HI. IL. MD, MI. NE. NM. NC.
       OR. TN. TX. UT. VT and WI
___ valid immigration documents demonstrating lawful presence.
       e.g.. current foreign passport with current I-551 stamp or visa,
       current foreign passport with I-94, I-94 with asylum status,
       unexpired Resident Alien card. Permanent Resident card or
       Employment Authorization card

*A waiver may be available where no identification exists
or can be obtained due to a medical condition. homelessness, or
insufficient documentation to receive a Colorado I.D. or driver's
license. Contact your department director.