Affidavit (Cash Law - Beer)
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Affidavit (Cash Law - Beer) Form. This is a Texas form and can be use in Alcoholic Beverage Commission Statewide.
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Tags: Affidavit (Cash Law - Beer), C-809, Texas Statewide, Alcoholic Beverage Commission
FORM C-809 (10/2004)
AFFIDAVIT
(CASH LAW – BEER)
STATE OF TEXAS
COUNTY OF
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 a
No.
(Check or instrument)
dated the
(Check or instrument No.)
day of
in the amount of
$
(Month/Year)
was received by the
(Manufacturer or Distributor Permittee)
of
Texas.
(City)
That said
was received in payment of BEER delivered on the
(Check or instrument)
day of
to the
(Month/Year)
(Retailer, Mixed Beverage or Private Club Permittee)
Permit number
located at
(Address of Retailer, Mixed Beverage or Private Club Permittee)
That on the
day of
said
(Month/Year)
(Check or instrument)
was dishonored by the drawee,
(Name and address of Bank)
for the following reason(s)
.
That said dishonored
was returned to
(Check or instrument)
on the
day of
(Manufacturer or Distributor Permittee)
, resulting in a violation of the cash law. (TABC Code 102.31)
Manufacturer or Distributor Permittee
Address
(Notary Seal)
Permit Number
Phone Number
Manufacturer or Distributor Representative’s Signature
Title
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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