Abandonment Affidavit
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Abandonment Affidavit Form. This is a Connecticut form and can be use in Department Of Consumer Protection Statewide.
Tags: Abandonment Affidavit, Connecticut Statewide, Department Of Consumer Protection
DCPLC-abandaff Rev 9/08
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
Liquor Control Division
Telephone: (860) 713-6210
Web Site: www.ct.gov/dcp
ABANDONMENT AFFIDAVIT
Date: _____________________
Permittee: ____________________________________________________
Trade Name: __________________________________________________
Address:
______________________________________________
______________________________________________
______________________________________________
Pursuant to section 30-48 (c) of Connecticut General Statutes, I attest that:
Neither I, ______________________________________________________________, nor the backer
_______________________________________________________, purchased anything from the previous
permit holder/backer.
Neither I, ________________________________________________________________, nor the backer
_______________________________________________________, received any benefit from the predecessor
for the abandonment of permittee/backer.
I do hereby affirm that the information contained in this affidavit is true to the best of my knowledge.
Signature of permittee, backer or authorized representative of the backer:
X _____________________________________________________ Date: ______________________
Subscribed and affirmed before me:
Signed X
_________Date
_______
(Commissioner of Superior Court, Notary Public, Justice of Peace)
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