Form Dbpr Abt-6035 - Application For Transfer Of Ownership Of An Alcoholic Beverage License Page 12
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15SECTION 14 - AFFIDAVIT OF TRANSFEROR
NOTARIZATION REQUIRED
Trade Name (D/B/A)
I, the undersigned, hereby swear or affirm that I am duly authorized to make this affidavit and do hereby
consent, on my behalf or on behalf of the transferor, to the above transfer, and represent to the Division of
Alcoholic Beverages and Tobacco that the license which is being transferred is as shown in the application
and that a bona fide sale in good faith has been made to the within applicant of the business for which the
foregoing transfer of license is sought.
STATE OF___________________
_________________________________________________
TRANSFEROR OR AUTHORIZED OFFICER SIGNATURE
COUNTY OF_________________
_________________________________________________
TRANSFEROR OR AUTHORIZED OFFICER SIGNATURE
The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged Before me this _______Day
of______________, 20_____, By _____________________________________ who is ( ) personally
known to me OR ( ) who produced ________________________________________as identification.
________________________________________________ Commission Expires: ___________________
Notary Public
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