Molena, GA · Pike County
Public Benefits Affidavit
This affidavit is for applicants seeking specified Georgia Department of Revenue licenses or permits who must verify their citizenship or immigration status and age under oath.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
Applicants use this affidavit to state under oath that they meet one of the listed citizenship or immigration-status categories, are at least 18 years old, and have provided a secure and verifiable document. The form lists state alcohol, tobacco, COAM, and motor fuel licenses or permits. It directs applicants to submit front and back copies of a secure and verifiable document with the affidavit.
Who needs it
Applicants for a listed Georgia Department of Revenue license or permit who must provide the affidavit and a front-and-back copy of a secure and verifiable document need this form.
How to get this notarized
- 1
Download the Affidavit
Get the Public Benefits Affidavit and review its license or permit options.
- 2
Complete the Form
Mark the applicable option and provide the requested applicant and document information.
- 3
- 4
- 5
Submit the Affidavit
Submit the notarized affidavit and front-and-back copies of your secure and verifiable document as directed.
Preview the form
The blank PDF straight from Molena. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete the public benefits affidavit?
- Select the applicable license or permit, complete the requested applicant information, and sign under oath before a notary. Submit the affidavit with front and back copies of a secure and verifiable document.
- Do I need to sign this affidavit in front of a notary?
- Yes. The form includes a subscribed-and-sworn jurat, so the applicant must sign under oath before the notary.
- Can I use a commissioned online notary for this affidavit?
- Georgia has no remote online notarization statute of its own. Georgia law recognizes acknowledgments taken by notaries of other states under O.C.G.A. §44-2-21. Since this form requires an oath, confirm with the city if unsure whether it accepts a remotely administered jurat.
- What document copies must I submit with the affidavit?
- The form instructs applicants to submit a front and back copy of a secure and verifiable document with the affidavit.