FORM C - 80 7 ( 03/ /201 9 ) BUSINESS RECORDS AFFIDAVIT (C REDIT LAW 226 LIQUOR) 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 , (Wholesaler, Winery, Local Distributor, Brewery, or Brewpub) permit number , located at,,Texas. (Physical Street Address) City As the Seller, I can attest to the fact that the attached records (invoices, accounts payable ledger sheets, etc.) represent unpaid charges for the payment of liquor products to the 223Retailer224 , permit number , located at (Retailer, Package Store, Mixed Beverage or Private Club) ,, Texas. (Physical Street Address) 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. 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(s) for product invoices during the time periods noted within the meaning of Tex. Alco. Bev. Code 247247 102.32, 11.61(b)(2), 11.66, and 109.64, and 16 Tex. Admin. Code 247 45.121: Delivery Period List Publication Date Invoice Number(s) Total Amount thru thru thru American LegalNet, Inc. www.FormsWorkFlow.com thru Page 2 of 2 thru thru thru thru thru thru Signature of Affiant Printed Name of Affiant ( )() Telephone # FAX # E-Mail Address SWORN TO AND SUBSCRIBED BEFORE ME, the undersigned authority, this day of , 20. (Notary Seal) Notary Public in and for the State of Texas 2 American LegalNet, Inc. www.FormsWorkFlow.com