Building Inspection Division 9500 Civic Center Dr. Thornton, Colorado 80229
Office 303-538-7250 e-mail buildings@cityofthornton.net
IMPORTANT INFORMATION
Starting January 1, 2007, pursuant to H.B. 06S-1009, C.R.S24-34-107, only persons lawfully present in
the United States will be issued a license. Therefore, ALL applicants for original licensure or licensees
renewing a current Colorado license after January 1, 2007 are required to complete and sign the
following Affidavit of Eligibility, and may also be required to provide valid identification when requested.
AFFIDAVIT OF ELIGIBILITY
Section A: LAWFUL PRESENCE in the United States
I, (please print your full name) , swear or affirm under
penalty of perjury under the laws of the State of Colorado that (check 1, 2, or 3 below):
1. I am a US citizen.
2. I am not a US citizen but am lawfully present in the US as evidenced by one of the following, (check
a, b, or c):
a. I am a qualified alien as defined in 8 U.S.C. sec 1641.
b. I am a nonimmigrant under the “Immigration and Nationality Act”, Federal Public Law
82-414 as amended.
c. I am an alien who is paroled into the US under 8 U.S.C. sec.1182 (d) (5).
3. I am a foreign national not physically present in the US under 8 U.S.C. sec 1621 (c) (2) (c) or
employed in the US pursuant to 8 U.S.C. 1621 (c) (2) (a).
Complete documentation must be provided upon request.
Section B: Secure and Verifiable Document. All areas in this section must be completed.
1. Please refer to attachment A (on the reverse of this form) for a list of acceptable secure and verifiable
documents and enter the documentation you have .
2. Please enter the name of the state or federal agency name where this was issued
.
3. What is the document number ?
4. What is the expiration date ?
Section C: Attestation.
I understand that this sworn statement is required by law because I have applied for or hold a
professional or commercial license regulated by 8 U.S.C. sec. 1621. I understand that state law requires
me to provide proof that I am lawfully present in the United States when asked as well as submission of
a secure and verifiable document. I may also be required to provide proof of lawful presence.
I understand that in accordance with sections 1808-503 and 18-8-501(2)(a)(I), C.R.S., false Statements
made herein are punishable by law. I state under penalty of perjury in the second degree, as defined in
18-8-503, C.R.S. that the above statements are true and correct.
I am the person identified above and that the information contained herein is true and correct to the best
of my knowledge. I understand that under Colorado law, providing false information is grounds for
denial, suspension or revocation of a license, certificate, registration or permit.
I understand that the above information must be disclosed to the Department of Regulatory Agencies
upon request and is subject to verification.
Signature Date
Colorado License No. and Type(if already licensed):