HomeMy WebLinkAboutAffidavit 3SECTION 6 AFFIDAVIT OF APPLICANT
FOR SPECIAL SALES LICENSE {''aa�'
:NOTARIZATION REQUIRED ° . '.
N of Entity or Orga tin e
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"I, the undersigned individual, or if a corporation for itself, its officers and directors, hereby swearrd� affirm
that I am duly authorized to make the above and foregoing application for a specia! sales license which
authorizes the sale of alcoholic beverages for period of up to three (3) days. I understand this license does
not permit the sale of alcoholic beverages for consumption on the premises and only allows package sales
in sealed containers and agree that the location may be inspected and searched during the hours that the
special sale 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
determiningcompliance with the beverages laws.
I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45, and
837.06, that the foregoing information is true to the best of my knowledge and that no other person or entity
except as indicated herein has an interest in the special sales license and that ail of the above listed
persons or entities meet the qualifications necessary to hold this special sales license."
STATE OF Flo>/ld0 , :
NfJ
COUNTY OF M? t(Qi111 -Jade.
/ APP NT NATURE
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The foregoing was ( ) Sworn to and Subscribed OR {) Acknowledged Before me this 4 0 Day
of 000ernbe( , 20 05 , By:. Q.hotri 111
A-.. Jhr son , •
who is ( ) personally known to me OR ( who produced .!Jt' ti2lt
�.ze a as identification.
_do. Xiomara Viilaverda
:r ( o. n My Commission DD2357B6
Expires July 28, 2007
072 Commission Expires: ' \ • •
Nola ublic