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I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. If further acknowledge that making a false,
fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the
criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute 18-
8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently
I declare, under penalty of perjury, that this application has been examined by me and that the statements made herein are to the best of my knowledge and belief, true, correct and complete.
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