Affidavit Form - City Of Independence, Missouri Finance Department (Page 2 of 4) in pdf

14.

Does the former owner of the business have any interest, either directly or indirectly, in the business for which you

seek a license?

If so, give details

15.

State names and addresses or any person, firm, LLC, or corporation that has advanced, or will advance, any money to

you to purchase or operate the business for which you seek a license

16.

If a RETAILER, does any distiller, wholesaler, winemaker, brewer, or supplier of coin or token-operated commercial,

manual, electric, or mechanical amusement device or any employee, officer, or agent thereof have any financial

interest in the business or will you either, directly or indirectly, borrow or accept from any such person or persons

equipment, money, credit or property of any kind except ordinary commercial credit for liquor sold?

If so, state details

17.

If a WHOLESALER, does any retailer or supplier of equipment or coin or token-operated commercial, manual, electric,

or mechanical amusement device, or any employee, officer or agent thereof have any financial interest in the business,

or will you either directly or indirectly borrow or accept from any such persons equipment, money, credit or property

of any kind except ordinary commercial credit for liquor sold?

If so, state details

18.

Is there now employed, or do you expect to employ, in the business sought to be licensed hereunder, any person who

has been convicted of, found guilty of, or pleaded guilty, no contest, or no lo contendere to any offense involving

a controlled substance, a weapon, illegal gambling, or the illegal sale, possession or use of alcohol, including alcohol-

related traffic offenses?

If so, state details

19.

Will you at all times permit the entry of any officer or investigator with legal authority for the purpose of inspection

or search; and will you permit the removal of all things and articles which may be in violation of the ordinances of

Independence, Missouri, and the laws of the State of Missouri; and do you consent to the introduction of such articles

as evidence in any proceedings for the violation of any provision of the revised liquor control ordinances of Indepen-

dence, Missouri; and/or for the suspension or revocation of the license for which this application is made; and do you

promise and agree not to violate any of the ordinances of Independence, Missouri, the laws of the State of Missouri or

the United States in the conduct of the business for which license is sought?

IF BUSINESS IS OWNED BY INDIVIDUAL, COMPLETE THE FOLLOWING:

20.

Name, home address, and telephone number of owner:

Affidavit Form - City Of Independence, Missouri Finance Department Page 2