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Puerto Rico Applicant Status Affidavit Form

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Puerto Rico Applicant Status Affidavit Form Page 2
Puerto Rico Applicant Status Affidavit Form
Name: SSN:
SECURE AND VERIFIABLE DOCUMENTS UNDER O.C.G.A. & 50-36-2
Initials:
A United States passport or passport card.
A United States military identification card.
A driver’s license issued by one of the United States, the District of Columbia, the Commonwealth of Puerto
Rico, Guam, the Common wealth of the Northern Marianas Islands, the United States Virgin Islands, American
Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying
information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable
the identification of the bearer.
An identification card issued by one of the United States, the District of Columbia, the commonwealth of
Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Islands,
American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient
identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and
address to enable the identification of the bearer.
A tribal identification card of a federally recognized Native American tribe, provided that it contains a
photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of
birth, gender, height, eye color, and address to enable the identification of the bearer.
A United States Permanent Resident Card or Alien Registration Receipt Card.
An Employment Authorization Document that contains a photograph of the bearer.
A passport issued by a foreign government.
A Merchant Mariner Document or Merchant Mariner Credential issued by the United States Coast Guard.
A Free and Secure Trade (FAST) card.
A NEXUS card.
A Secure Electronic Network for Travelers Rapid Inspection (SENTRI) card.
A driver’s license issued by a Canadian government authority.
A Certificate of Citizenship issued by the United States Department of Citizenship and Immigration
Services (USCIS).
A Certificate of Naturalization issued by the United States Department of Citizenship and Immigration
Services (USCIS) (Form N-550 or Form N-570).
DOL-1054A (R-8/13) Side 2
Puerto Rico Applicant Status Affidavit Form
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