2025-26 Trees Atlanta Smyrna Front Yard Program Agreement- Updated
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18 July 24, 2025 EXHIBIT B AFFIDAVIT VERIFYING STATUS FOR CITY PUBLIC BENEFIT APPLICATION By execu ting this affidavit under oath, as an applicant for a Smyrna, Georgia Business License or Occupation Tax Certificate, Alcohol License, Taxi Permit, execution of contract or other public benefit as referenced in O.C.G.A. §50-36-1, I, Greg Levine, hereby state the following with respect to my application for a Smyrna license/permit and/or contract for Trees Atlanta, Inc.: 1. ____X______ I am a United States citizen OR 2. __________ I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non-immigrant under the Federal Immigration and Nationality Act 18 years 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 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. Signature of Applicant: ______________________________________ Date: _____________________________________ Printed Name: Greg Levine___________________________ *Alien Registration number for non-citizens: _______________________ **PLEASE INCLUDE A COPY OF YOUR PERMANENT RESIDENT CARD, EMPLOYMENT AUTHORIZATION, GREEN CARD, OR PASSPORT WI TH A COPY OF YOUR DRIVER’S LICENSE IF YOU ARE A LEGAL PERMANENT RESIDENT (#2). Subscribed and Sworn Before Me, this the __________ day of _________________________, 20_ _. Notary Public: _______________________________________________________________________ My Commission Expires: _________________________________ *Note: O.C.G.A. § 50-36-1(e)(2) requires that aliens under the Federal Immigration and Nationality Act, Title 8 U.S.C., as amended, provide their alien registration number. Because legal permanent residents are included in the Federal definition of “alien”, legal permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number may supply another identifying number below: ______________________________________________