Required Documents for COAM Location License Application

with Only Class A Machines

Document Checklist

All applicants for a Coin Operated Amusement Machine (COAM) License and those applying for
renewal of an existing license are required to submit:

1. a signed and sworn (notarized) Verification of Lawful Presence Within the United States
Affidavit verifying the applicants lawful presence in the United States, and
2. A legible front and back copy of their applicable Secure and Verifiable Document.
Attached is a complete list of acceptable Secure and Verifiable Documents.

Note: Your application cannot be renewed or approved until all the documents are completed
and returned to the Georgia Lottery.

How to Fill Out the Affidavit: The affidavit must be completed by the licensee. If the licensee is a
business, an affidavit must be completed and signed by only one owner, officer, partner, member,
or responsible party of the business.

a) Legal Business Name Prefilled as entered in the COAM website.
b) Citizenship Status Check any one of the three options that best describes your
citizenship status.
c) If you are a qualified alien or non-immigrant under the Federal Immigration and
Nationality Act, provide your alien number issued by the Department of Homeland
Security or other federal immigration agency.
d) Provide the type of Secure and Verifiable Document that you will submit with your
affidavit. Attached is a complete list of acceptable Secure and Verifiable Documents.
Mail the completed documents listed above to:

Georgia Lottery Corporation
COAM Department
P.O. Box 56927
Atlanta, GA 30343

Purpose of the affidavit: Georgia Law (O.C.G.A. 50-36-1, et seq.) requires the GLC to verify the lawful presence
within the United States of all applicants for licenses, and, when necessary, utilize the Systematic Alien Verification for
Entitlements (SAVE) Program to confirm an applicants lawful presence in the United States. The SAVE Program is an
intergovernmental information-sharing initiative designed to assist Federal, State government agencies and non-
governmental agencies, such as licensing bureaus, in determining an individuals immigration status. The information
provided by SAVE will ensure that only entitled applicants will be granted the license for which they applied. SAVE
only provides the immigration status of these individuals and does not make determinations or recommendations
regarding a non-citizens eligibility for the license.





Acceptable Secure and Verifiable Documents
Under O.C.G.A. 50-36-2

An unexpired United States passport or passport card
An unexpired United States military identification card
An unexpired Drivers license or Identification Card issued by one of the United States, District of
Columbia, Commonwealth of Puerto Rico, Guam, Commonwealth of the Northern Marianas Islands,
United States Virgin Island, American Samoa, or 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 unexpired 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 listing of federally recognized Native American tribes may be found at:
http://www.bia.gov/WhoWeAre/BIA/OIS/TribalGovernmentServices/TribalDirectory/ ind ex.htm
An unexpired United States Permanent Resident Card or Alien Registration Receipt Card
An unexpired Employment Authorization Document that contains a photograph of the bearer
An unexpired Passport issued by a foreign government, provided that such passport is accompanied
by a United States Department of Homeland Security (DHS) Form I-94, DHS Form I-94A, DHS
Form I-94W, or other federal from specifying an individuals lawful immigration status or other
proof of lawful presence under federal immigration law.
An unexpired Merchant Mariner Document or Merchant Mariner Credential issued by the United
States Coast Guard.
An unexpired Free and Secure Trade (FAST) card.
An unexpired NEXUS card.
An unexpired Secure Electronic Network for Travelers Rapid Inspection (SENTRI) card.
An unexpired Drivers license issued by a Canadian government authority.
Certificate of Citizenship issued by the United States Department of Citizenship and Immigration
Services (USCIS) (Form N-550 or Form N-570)
Certificate of Naturalization issued by the United States Department of Citizenship and
Immigration Services (USCIS) (Form N-550 or Form N-570)
Certification of Report of Birth issued by the United States Department of State (Form DS-1350)
Certification of Birth Abroad issued by the United States Department of State (Form FS-545)
Consular Report of Birth Abroad issued by the United States Department of State (Form FS-240)
An original or certified copy of a birth certificate issued by a State, county, municipal authority, or
territory of the United States bearing an official seal
In addition to the documents listed herein, if, in administering a public benefit or program, an agency
is required by federal law to accept a document or other form of identification for proof
of or documentation of identity, that document or other form of identification will be deemed a
secure and verifiable document solely for that particular program or administration of that particular
public benefit.