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Non-Resident License Affidavit

The document is a Social Security Number Affidavit for individuals applying for a professional or occupational license in Colorado. It states that the applicant does not have a social security number and is not a resident or physically present in the U.S. The affidavit includes a declaration under penalty of perjury regarding the truthfulness of the information provided.

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673 views1 page

Non-Resident License Affidavit

The document is a Social Security Number Affidavit for individuals applying for a professional or occupational license in Colorado. It states that the applicant does not have a social security number and is not a resident or physically present in the U.S. The affidavit includes a declaration under penalty of perjury regarding the truthfulness of the information provided.

Uploaded by

matraasia584796
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Colorado Department of Regulatory Agencies

Division of Registrations
1560 Broadway, Suite 1350
Denver, CO 80202
Phone: (303) 894-7800

SOCIAL SECURITY NUMBER AFFIDAVIT

AFFIDAVIT OF
(Applicant’s Name)

I, being first sworn, depose and state the


following under oath:

1. I am applying for a professional or occupational license or certificate in the State of


Colorado for the profession or occupation of .

2. I do not have a social security number and I am not a resident of the United States nor
am I physically present in the United States.

3. I state under penalty of perjury in the second degree, as defined in 18-8-503, Colorado
Revised Statutes, that the information contained herein is true and correct to the best of
my knowledge.

4. I understand that under Colorado law, providing false information is grounds for denial,
suspension or revocation of a professional or occupational license or certificate.

Further Affiant Sayeth Naught

Name and Address

Subscribed and sworn to before me on this day of , .

Notary Public

My Commission expires: .

Updated January 2009

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