FORM C - 809 ( 03 /201 9 ) BUSINESS RECORDS AFFIDAVIT Page 1 of 2 (CASH LAW 226 MALT BEVERAGES) 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: My name is . I am of sound mind, capable of making this affidavit and personally acquainted with the facts herein stated. As a , (Job Title) I am the custodian of records for the 223Seller224, (Manufacturer, Distributor, Brewpub, Local Distributor - LP) Permit/License number , located at , (Physical Street Address) , Texas. . (City) Attached hereto are pages of records from the Seller, regarding the sale and delivery of malt beverage products to the 223Retailer224 , (Retailer, Mixed Beverage or Private Club Permittee) Permit/License number located at , (Physical Street Address) , Texas. (City) The attached said pages of records are kept by the Seller in the regular course of business, and it was the regular practice of the Seller222s employee or representative with knowledge of the act, event, condition, opinion, or diagnosis, recorded to make the record or to transmit information thereof to be included in such record; and the record was made at or near the time or reasonably soon thereafter. The records attached hereto are the original or exact duplicates of the original. 1 American LegalNet, Inc. www.FormsWorkFlow.com After a diligent search of the Seller's business records, there is no record or entry of such record that the Retailer made a timely payment, within the meaning of Tex. Alco. Bev. Code 247 102.31, and 16 Tex. Admin. Code 247 45.131 for the following invoice number(s): Instrument Date Instrument # In strument Amount Instrument Date Instrument # Instrument Amount Signature of Affiant Telephone Number Fax Number E-Mail Address SWORN TO & SUBSCRIBED BEFORE ME, the undersigned authority, this day of ,. (Notary Seal) Notary Public in and for the State of Texas 2 American LegalNet, Inc. www.FormsWorkFlow.com