Special Events License Form/affidavit Of Character/liquor License Application Criminal Record Check

CITY OF SULPHUR SPECIAL EVENT PERMIT APPLICATION cont’d

Business Name:__________________________________________________________________________________________

Business Address: ________________________________________________________________________________________

STATE OF LOUISIANA

CALCASIEU PARISH

AFFIDAVIT OF CHARACTER

Applicant shall not be the spouse of a person who does not meet the following requirements:

BEFORE ME, the undersigned Notary Public, personally came and appeared ____________________________________________, who,

after being duly sworn, did dispose and say that:

He/She is a person of good character and reputation and over 21 years of age. He/She is also a citizen of the United States and of the State

of Louisiana and a resident of the State of Louisiana continuously for a period of not less than two years next preceding the date of the filing of

the application unless a corporation or limited liability company is organized under the laws of the state of Louisiana. The requirements as to

Louisiana citizenship do not apply to wholesalers or retailers who held permits on or prior to January 1, 1964.

I or my spouse has never been convicted of a felony under the laws of the State of Louisiana or any other state or country; that I have never

had any license to sell or deal in alcoholic beverages revoked by any state or the United States within five (5) years prior to the date of this

application.

He/She also affirms that he/she has not been convicted of a felony under the laws of the United States, the State of Louisiana, or any other

state or country and that he/she has not been convicted of soliciting of prostitution, contributing to the delinquency of juveniles, keeping a

disorderly place or illegally dealing in narcotics.

He/She also affirms that he/she has not had license or permit to sell or deal in alcoholic beverages, issued by the United States, any state, or

by any political subdivision of a state authorized to issue permits or licenses, revoked within one year prior to the time of application, or been

convicted or had a judgment of court rendered against him/her involving alcoholic beverages by this or any state or by the United States for one

year prior to this application.

He/She also affirms that he/she has not been adjudged by a board or convicted by a court of violating any of the provisions of the State

statutes regarding alcoholic beverages and that he/she has not been convicted of violating any municipal or parish ordinances adopted pursuant

to the provisions of these statutes. He/She also affirms that he/she is not the spouse of a person whose application has been denied or whose

permit has been revoked, unless judicially separated or divorced.

Affiant understands that the affidavit is being made for the express purpose of satisfying the requirements of LA. R.S. 26:79 and La. R.S.

14:91.3

_______________________________________________________________________

(Affiant)

SWORN TO AND SUBSCRIBED BEFORE ME, this___________________day

of _______________________________________, ______________.

______________________________________________________________________

NOTARY PUBLIC

Special Events License Form/affidavit Of Character/liquor License Application Criminal Record Check - City Of Sulphur Page 2