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Get GA DOL-1054A 2017-2024

Ity Number is . I present here my unexpired government-issued picture identification in support of this declaration of my name and identity. I am an applicant for a public benefit, and I am making the representations in this AFFIDAVIT to obtain that public benefit. 2. I was born in [NAME OF COUNTRY] of age or older. on / / , and I am 18 years 3. I declare [INITIAL ONE]: [ ] that I am a U.S. Citizen; OR [ ] that I am a legal permanent resident; OR [ ] that I am a qualified alien or non-.

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