SAVE Affidavit

  1. Answer all questions in the application.  For those questions that do not apply, enter "N/A".
  2. Print the application using the print button on the last page of the application. 
  3. Make sure that the application is SIGNED and NOTARIZED.  
  4. If you are having difficulty completing the online form, download and complete the PDF version of the SAVE Affidavit (PDF)
  5. Attach a copy of verifiable identification to the SAVE Affidavit.  Download a list of approved verifiable Identifications. 

SAVE Affidavit

  1. SAVE Affidavit

    O.C.G.A. §50-36-1(e)(2) Affidavit 

  2. By executing this affidavit under oath, as an applicant for a(n)

  3. LLC, Corporation, Sole Proprietorship , etc.

  4. as referenced in O.C.G.A §50-36-1, from the Greene County Board of Commissioners, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 

  5. Citizenship
  6. The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. §50-36-1(e)(1), with this affidavit.

  7. The secure and verifiable document provided with this affidavit can best be classified as
  8. In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. §16- 10-20, and face criminal penalties allowed by such statute. 

    Executed on the______ day of ___________________, 20____ in,___________________________________

    Signature of Authorized Officer or Agent

    Printed Name of and Title of Authorized Officer or Agent 

    SUBSCRIBED AND SWORN BEFORE ME ON THIS THE _______ DAY OF _______________________, 20________

    Notary Public

    My Commission Expires


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