Affidavit Of Applicant For Wholesaler Permit
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Affidavit Of Applicant For Wholesaler Permit Form. This is a Louisiana form and can be use in Office Of Alcohol And Tobacco Control Statewide.
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Affidavit of Applicant for Wholesaler Permit
Before me, the undersigned Notary Public, personally came and appeared the
undersigned person, who, after being duly sworn did depose and state that:
1. I have read and understood each of the questions contained in this application;
2. The answers given to each question contained in this application are true and correct to
the best of my knowledge and belief;
3. I meet the qualifications and conditions set out in Louisiana Revised Statutes 26:80 and
280;
4. I have no interest whatsoever in any establishment holding a retail beer or liquor permit;
5. I understand that any misstatement or suppression of fact in this application or any
accompanying documents is grounds for denial of this application for a wholesale permit.
____________________________________________
Signature of Applicant
Printed Name
Social Security Number
Title
Business
Subscribed before me, the undersigned Notary Public, on this
the city of
, parish of
, State of Louisiana.
day of
, 20
in
Notary Public
____________________________________________
Signature
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