Affidavit (Bank Error)
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Affidavit (Bank Error) Form. This is a Texas form and can be use in Alcoholic Beverage Commission Statewide.
Tags: Affidavit (Bank Error), C-812, Texas Statewide, Alcoholic Beverage Commission
Form C-812 (9/2010)
STATE OF TEXAS
BEFORE ME, the undersigned authority, this day personally appeared __________________________________,
who is a credible person, and who, after being by me duly sworn, did depose and say:
That I am an officer of ______________ located at ___________________________________.
(Name of Bank)
This is to certify that Check Number _____________ dated _____________________
in the amount _________________________ , made payable to __________________________
(Name of Permittee)
Drawn on the account of, or endorsed by ____________________ operator of ____________________________,
(Name of Representative)
(Name of Retailer, Mixed Beverage, or
Private Club Permittee)
which was dishonored on the ___________ day of _______________________
by this bank for insufficient funds when presented for payment was the result of an error by this bank.
On the __________day of ________________ when the above check was presented for payment, there were
adequate funds on deposit at that time.
Bank Representative’s Signature
SWORN TO AND SUBSCRIBED BEFORE ME, the undersigned authority, this the _______________
day of _________________ AD,__________________________ .
Notary Public in and for the State of Texas
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