Waiver Of Minimum Distance Requirments By A Church Or Funeral Home
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Waiver Of Minimum Distance Requirments By A Church Or Funeral Home Form. This is a Mississippi form and can be use in State Tax Commission Statewide.
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ABCD 1012 (Revised 11/95)
WAIVER OF MINIMUM DISTANCE REQUIREMENTS
BY
A CHURCH OR FUNERAL HOME
The undersigned, ________________________________________________
(name of entity)
whose Post Office address is _______________________________________
and street address is ______________________________________________
and having full knowledge of the distance limitations imposed by Section 67-151 (3), 1972 MCA, upon an Alcoholic Beverage Control permitted business, do
hereby waive the right to object to the issuance of an alcoholic beverage
retailers permit to _________________________________________________
(name of business)
whose street address is ___________________________________________.
(street)
(city)
(county)
I certify that I am vested with authority on behalf of _______________________
(name of entity)
to issue this waiver of the distance limitations as set forth in Section 67-1-51 (3),
1972 MCA. I further understand that this waiver has no expiration date and will
remain in effect for the duration of the alcoholic beverage retailers permit for
which it is executed.
SIGNED, this the ___________ day of _____________________ , _________ .
__________________________________________
(signature of authorized person)
WITNESS
_______________________________
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