BEASON-HAMMON ALABAMA TAXPAYER AND CITIZEN PROTECTION ACT
AFFIDAVIT OF SOLE PROPRIETORSHIP WITHOUT EMPLOYEES

State of _________________________________________

County of _________________________________________

Before me, a notary public, personally appeared ________________________________ (print name)
who, being made known to me and being duly sworn to give true testimony, did say as follows:

I am _____________________________________(print name). I am over the age of eighteen years.
I have taken an oath, or do hereby affirm, that all I say herein is the truth.

I am entering into, or attempting to enter into, a business transaction with the State of Alabama or a
political subdivision of the State of Alabama. I do business as a sole proprietor and will be
personally performing my duties in this business transaction as a sole proprietor. No individuals are
employed by my sole proprietorship.

_______________________________________
Signature of Affiant

Sworn to or affirmed, and subscribed before me, on this _____day of ___________________, 2____.

_______________________________________
Signature of Notary Public

My Commission expires on ____________

__________________________________
PRINT NAME

(Affix Seal)

b - sole proprietor e verify affidavit and list of u s citizenship proof 03 27 2012

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1) The applicant's driver's license or non-driver's identification card issued by the division of motor
vehicles or the equivalent governmental agency of another state within the United States if the agency
indicates on the applicant's driver's license or non-driver's identification card that the person has
provided satisfactory proof of United States citizenship.

(2) The applicant's birth certificate that verifies United States citizenship to the satisfaction of the
county election officer or Secretary of State.

(3) Pertinent pages of the applicant's United States valid or expired passport identifying the applicant
and the applicant's passport number, or presentation to the county election officer of the applicant's
United States passport.

(4) The applicant's United States naturalization documents or the number of the certificate of
naturalization. If only the number of the certificate of naturalization is provided, the applicant shall
not be included in the registration rolls until the number of the certificate of naturalization is verified
with the United States Bureau of Citizenship and Immigration Services by the county election officer
or the Secretary of State, pursuant to 8 U.S.C. § 1373(c).

(5) Other documents or methods of proof of United States citizenship issued by the federal
government pursuant to the Immigration and Nationality Act of 1952, and amendments thereto.

(6) The applicant's Bureau of Indian Affairs card number, tribal treaty card number, or tribal
enrollment number.

(7) The applicant's consular report of birth abroad of a citizen of the United States of America.

(8) The applicant's certificate of citizenship issued by the United States Citizenship and Immigration
Services.

(9) The applicant's certification of report of birth issued by the United States Department of State.

(10) The applicant's American Indian card, with KIC classification, issued by the United States
Department of Homeland Security.

(11) The applicant's final adoption decree showing the applicant's name and United States birthplace.

(12) The applicant's official United States military record of service showing the applicant's place of
birth in the United States.

(13) An extract from a United States hospital record of birth created at the time of the applicant's
birth indicating the applicant's place of birth in the United States.

b - sole proprietor e verify affidavit and list of u s citizenship proof 03 27 2012

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