2025-26 Trees Atlanta Smyrna Front Yard Program Agreement- Updated

Open official source ↗ · Source page 18

Text from the cited document · page 18

Document text may contain formatting or transcription errors. Use the original document to check the wording.

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: 
 
______________________________________________