Fillable Affidavit of lawful presence (State of Oklahoma)

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Affidavit of lawful presence (State of Oklahoma)

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U.S.A. forms for State of Oklahoma

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OMMA.ok.gov
Oklahoma Medical Marijuana Authority Page 1 of 2 Afdavit of Lawful Presence Form & Procedure | Version 1.1 (08/2018)
THE PERSON SIGNING THIS FORM MUST READ THESE INSTRUCTIONS CAREFULLY:
1. If the applicant is a citizen of the United States then check the box to the left of the statement, “The applicant is a citizen of the
United States.” If the person signing this form is not a citizen of the United States then the person should check the box to the left of
the statement, “The applicant is an approved alien under the Federal Immigration and Nationality Act and is approved to be present
in the United States.”
2. Write the identication number in the space provided after “Admission/Registration #” and write the name of the authorizing
document in the space provided after “Authorizing Document.” For example, INS Form 1-551 or INS Form 1-94. See page 2 for
valid documentary evidence of lawful presence.
3. The person signing this form should write today’s date in the space provided; write the city and state where they are located when
they signed this form; sign their name in the space provided for signature; and print their name in the space provided. If applying for
a renewal, write the license number in the space provided. Within this form, the term “penalty of perjury” means the willful assertion
of the fact of either United States citizenship or lawful presence in the United States as a qualied alien, and made upon one’s oath
or afrmation and knowing such assertion to be false.
4. Making such a willful assertion on this form knowing it to be false is a crime in Oklahoma and may be punishable by a term of
incarceration of not more than ve (5) years in prison. Additionally, one who procures another to commit perjury is guilty of the crime
of subornation of perjury and may be punished in the same manner, as he would be if personally guilty of the perjury so procured.
APPLICANT INFORMATION
(Choose one) NEW APPLICATION RENEWAL APPLICATION
License # (if applying for renewal)
First Name Middle Name Last Name Sufx Date of Birth (mm/dd/yy)
Current Physical Street Address APT# City State Zip
ATTACH A COPY OF THE FRONT AND BACK OF YOUR AUTHORIZING DOCUMENT IF APPLICABLE.
Admission/Registration# Name of Authorizing Document Attached
(Choose one)
THE APPLICANT IS A CITIZEN OF THE UNITED STATES
THE APPLICANT IS AN APPROVED ALIEN UNDER THE FEDERAL IMMIGRATION AND NATIONALITY ACT
AND A APPROVED TO BE PRESENT IN THE UNITED STATES.
PLEASE PRINT OR TYPE CLEARLY
Signature: Date:
Affidavit of lawful presence
by person making application for a license
Website: OMMA.ok.gov | Email: OMMA@ok.gov | Phone: (405) 522-OMMA
OMMA.ok.gov
Oklahoma Medical Marijuana Authority Page 2 of 2 Afdavit of Lawful Presence Form & Procedure | Version 1.1 (08/2018)
The Oklahoma Medical Mariujana Authority (OMMA) participates in the Systematic Alien Verication for Entitlements
(SAVE) Program, which is an intergovernmental information-sharing initiative designed to aid in determining a non-citizen
applicant’s immigration status (lawful presence), and thereby ensuring only U.S Citizens and eligible non-citizens receive
government benets, such as licenses. OMMA may only issue licenses to Qualied Aliens (non-U.S. citizens) who present valid
documentary evidence of one (1) of the following:
Alien Lawfully Admitted for Permanent Residence:
• INS Form I-551 (Alien Registration Receipt Card,
commonlyknown as a “green card”); or
• Unexpired Temporary I-551(Stamp in foreign passport or onINS
Form I-94).
Immigrant or Non-Immigrant Visa Status:
• INS Form I-94
• INS Form I-688B
Asylee:
• INS Form I-94 annotated with stamp showing grant of
asylumunder §208 of the INA;
• INS Form I-688B (Employment Authorization Card)
annotated“27a .12 (a) (5)”;
• INS Form I-766 (Employment Authorization Document)
annotated “AS”;
• Grant letter from the Asylum Office of INS; or
• Order of an immigration judge granting asylum.
Refugee:
• INS Form I-94 annotated with stamp showing admission
under§207 of the INA;
• INS Form I-688B (Employment Authorization Card)
annotated“274 a.12 (a) (3)”;
• INS Form I-766 (Employment Authorization Document)
annotated “A3”; or
• INS Form I-571 (Refugee Travel Document);
• Alien Who Has Been Battered or Subjected to Extreme Cruelty;
• INS petition and appropriate supporting documentation.
Alien Paroled Into the U.S. for a least One Year:
• INS Form I-94 with stamp showing admission for at least
oneyear under §212 (d) (5) of the INA (applicant cannot
aggregateperiods of admission for less than one year to meet
the one-year requirement).
Alien Whose Deportation or Removal Was Withheld:
• INS Form I-688B (Employment Authorization Card)
annotated“274 a.12 (a) (10)”;
• INS Form I-766 (Employment Authorization Document)
annotated “A10”; or
• Order from an immigration judge showing deportationwithheld
under §243 (h) of the INA as in effect prior to April 1,1997, or
removal withheld under §241 (b) (3) of the INA.
Alien Granted Conditional Entry:
• INS Form I-94 with stamp showing admission under §203 (a) (7)
of the INA;
• INS Form I-688B (Employment Authorization Card)
annotated“274 a.12 (a) (3)”; or
• INS Form I-766 (Employment Authorization Document)
annotated “A3”.
Cuban/Haitian Entrant:
• INS Form I-551 (Alien Registration Receipt Card,
commonlyknown as a “green card”) with the code CU6, CU7,
or CH6;
• Unexpired temporary I-551 stamp in foreign passport or on
INSForm I-94 with the code CU6 or CU7; or
• INS Form I-94 with stamp showing parole as “Cuba/
HaitianEntrant” under § 212 (d) (5) of the INA.
State law requires the Oklahoma Medical Mariujana Authority to verify the immigration status
(lawful presence) of all non-U.S. citizens upon initial license and renewal.
QUALIFIED ALIENS MUST ATTACH A COPY (FRONT & BACK) OF THE DOCUMENTS
that supports their status as shown above with their Afdavit of Lawful Presence.
A license will not be issued until the appropriate documentation is submitted.
Renewal applicants with new immigration documents are required to mail the new immigration
documentation listed above to establish eligibility for renewal.
Valid documentary evidence of lawful presence
DISPENSARY - GROWER - PROCESSOR -
TRANSPORTER - WASTE - LABORATORY
Website: OMMA.ok.gov | Email: OMMA@ok.gov | Phone: (405) 522-OMMA
QUALIFIED ALIENS
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Affidavit of lawful presence (State of Oklahoma)

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Completed 3 March 2022

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