AFFIDAVIT OF COMPLIANCE REGARDING NOTICE POSTING State Form 51188 (12-02) INSTRUCTIONS: 1. Type or print legibly. 2. Complete all sections. STEP 1. GENERAL INFORMATION Permit Number Permit Type Applicant's Name Address of premise Type of Application New Application Transfer of Location Transfer of Ownership Transfer of Stock STEP 2. SIGNATURES The undersigned applicant(s) for a permit concerning alcoholic beverages, swears or affirms that a Public Notice of Application has been continuously and conspicuously posted on the premises for which the license is applied, in the manner prescribed by the Alcohol and Tobacco Commission, for no less than ten (10) days prior to the scheduled Local Board hearing. The sign was first posted on (month/day/year) Signature (Sole Owner, President, or Partner **) Date Signature (Secretary or Partner **) Date The foregoing statements are provided under penalty of perjury, IC 7.1-3-1-28 and ATC rules. This affidavit must be submitted at the Local Board hearing. The Public Notice of Application must be posted for no less than ten (10) days prior to the scheduled Local Board hearing. ** The same person or persons who signed the actual application or notice must execute this affidavit. If the applicant is a corporation, the corporate president and secretary who signed the application of notice shall execute this affidavit by affixing the same signatures and titles. American LegalNet, Inc. www.FormsWorkflow.com