Fillable CITY OF WARNER ROBINS --Warner Robins, Georgia CONTRACTOR (City of Warner Robins)

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CITY OF WARNER ROBINS --Warner Robins, Georgia CONTRACTOR (City of Warner Robins)

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CITY OF WARNER ROBINS
--Warner Robins, Georgia
GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT - 1-
OCGA 13-10-90
“CONTRACTOR AFFIDAVIT AND AGREEMENT”
COMES NOW ________________________, who, being first duly sworn deposes and shows on
oath the following, to-wit:
I am the sole proprietor of a business known as ________________________________
and have no employees other than myself.
This affidavit is given to establish my compliance with the provisions of O.C.G.A. §
13-10-91(b)(5). I further state that am aware of the criminal and civil penalties for
violation of this section.
Affiant further sayeth not.
This _______ day of ___________________, 20_____.
_______________________________________________________
Signature of Applicant
_______________________________________________________
Print Name of Authorized Officer or Agent
_______________________________________________________
Business Name
SUBSCRIBED AND SWORN BEFORE ME ON THIS THE
______ DAY OF _____________________, 20_____
_____________________________________________
Notary Public
My Commission Expires: ______________________
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CITY OF WARNER ROBINS --Warner Robins, Georgia CONTRACTOR (City of Warner Robins)

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Completed 17 July 2020

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