July, 2012 3
Secondary Metals Recycler Registration – Registrant Affidavit
I hereby swear and affirm that all information provided in this registration form is true and correct to the best of my
knowledge and belief. I further swear and affirm that I have read and understand the current state laws relating to
secondary metals recyclers in Georgia and I agree to abide by these laws, as amended from time to time.
By signing this application, I hereby swear and affirm one of the following to be true and accurate pursuant to O.C.G.A. §
1. _______ I am a United States citizen 18 years of age or older. Please submit a copy of your current Secure
and Verifiable Document(s) such as driver’s license, passport, or other approved documentation.
2. _______ I am not a United States citizen, but I am a legal permanent resident of the United States 18 years of age
or older, or I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act 18 years
of age or older with an alien number issued by the Department of Homeland Security or other federal immigration
agency. Please submit a copy of your current immigration document(s) which includes either your Alien number
or your I-94 number and, if needed, SEVIS number.
By signing below, I acknowledge that I understand that I must comply with all Georgia laws relevant to secondary metals
recyclers at all times.
I am informed of the statutes pertaining to the Secondary Metals Recyclers pursuant to HB872, and the following
statutes O.C.G.A. § 10-1-350 through O.C.G.A. § 10-1-363, O.C.G.A. § 40-3-36, O.C.G.A. § 40-3-56.
I acknowledge that I understand the definition of secondary metals recycler as defined in O.C.G.A. § 10-1-350.
'Secondary metals recycler' means any person who is engaged, from a fixed location or otherwise, in the business in this
state of paying compensation for regulated metal property that has served its original economic purpose, whether or not
engaged in the business of performing the manufacturing process by which regulated metal property is converted into raw
material products consisting of prepared grades and having an existing or potential economic value.
I understand I may visit www.georgiarecyclers.org for a summary of the laws relevant to Georgia secondary
metals recycler information provided by The Georgia Recyclers Association but I understand that this summary
does not substitute the advice of legal counsel or reading of the actual laws.
In making the above attestation, I understand that making any false statements or writings on any part or portion of this
application is a violation of O.C.G.A. 16-10-20. Failure to make full and accurate disclosures may result in criminal
Signature of Individual Completing Registration Application Date
Print Individual Completing Registration Application
TO BE COMPLETED IN THE PRESENCE OF THE SHERIFF OR HIS DESIGNEE UPON
SUBMISSION OF THIS APPLICATION TO THE APPROPRIATE SHERIFF’S OFFICE
Secondary Metals Recycler Signature Date
Sheriff or Sheriff’s Designee Signature Date
Effective Date of Registration Expiration Date of Registration
WAYNE COUNTY SHERIFF'S OFFICE