HomeMy WebLinkAboutAffidavit 2SECTION 5 AFFIDAVIT'OF APPLICANT
FQR NON-PROFIT CIVIC ORGANIZATION ALCOHOLIC BEVERAGE PERMIT
bTARIZATION REQUIRED
Name of Entity or Organization
"This is to certify that the applicant requesting the permit in the above and foregoing application jrs a non-
profit civic organization and that the permit, if used, will be used only by the organization making application,
on the date(s) requested and at the location stated. This is to further -certify that the applicant organization
has not received more than three (3) permits within the calendar year and agree that the location may be
inspected and searched during the time that the permit is issued and business is being conducted without a
search warrant by authorized agents or employees of the Division of Alcoholic Beverages and Tobacco, the
Sheriff, his Deputies, and Police Officers for purposes of determining compliance with the alcoholic
beverage laws.
I, the undersigned individual, hereby swear or affirm that I am duly authorized to make the above and
foregoing statements on behalf of the applicant organization. Furthermore, I swear under oath or affirmation
under penalty of perjury as provided for In Sections 559.791, 562.45, and 837.06, Florida Statutes, that the
foregoing information is true to the best of my knowledge."
STATE OF florlda
COUNTY OF Mja�t.-bade
AP IC, NT ,Lr` AT RE
41
The foregoing was ( ) Sworn to and Subscribed OR U
+-C' /� �� ( ) Acknowledged Before me this Day
of f. rn bei , 20 05 , By: o }-4-�-I.,} . �. J linen
who is ( ) personally known t
<4WS
Notary PiIc
OR (VS./who produced D(1VQ(L C_ente as identification.
issf Xiomara VHlaverde
+ My Commission D0235788
r Expires July 29, 2007
Commission Expires. •