Self Certification For Compliance
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Self Certification For Compliance Form. This is a Kentucky form and can be use in Alcohol Beverage Control Statewide.
Tags: Self Certification For Compliance, Kentucky Statewide, Alcohol Beverage Control
ABC Edu. Fin. Asst. Self-Certification
SELF-CERTIFICATION FOR COMPLIANCE WITH
KRS 164.772 Default in repayment obligation under financial assistance
program – Professional licensing and certification – Notification.
This form must be completed (signed and dated) by all persons
interested in this application, including, but not limited to, officers,
partners, and managing members.
If this involves more than one person, make copies in order that each
such interested person completes this form.
Certification of Repayment of Educational Financial Assistance
I, _______________________________________________, am an applicant
for a license related to alcohol or alcoholic beverages issued by the
Kentucky Office of Alcoholic Beverage Control. I hereby certify that I am
not in default of a repayment obligation, such as a student loan repayment,
under any financial program administered by the Kentucky Higher
Education Assistance Authority (KHEAA).
Signature of applicant
RETURN THIS COMPLETED FORM TO STATE ABC ALONG WITH YOUR APPLICATION
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