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Short-term Rental SAVE Affidavit Union County Government 65 Courthouse Street, Blairsville, GA 30512 [PHONE REDACTED] SAVE AFFIDAVIT (U.S. Citizens are only required to provide this affidavit one time.) By executing this affidavit under oath, as an applicant for a Union County Short-term Rental License as referenced in O.C.G.A. § 50-36-1, from the Union County Commissioner’s Office, the undersigned applicant verifies one of the following with respect to the application for a public benefit: Please check one box only I am a United States citizen. I am a legal permanent resident of the United States. I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. Alien Number: 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 with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: (Type of Document) In making this 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 as allowed by such criminal statute. Executed in SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF Signature of Applicant: Printed Name: Date: Notary Public My Commission Expires: Affix Notary Stamp/Seal Here.