Affidavit Form - City Of Independence, Missouri Finance Department

CITY OF INDEPENDENCE

Finance Department - License Division

111 East Maple

Independence, Missouri 64050

Telephone 816-325-7079

Business Name

Business Address

AFFIDAVIT

, under oath, do hereby state that

I am engaged in

(Type of business, other than liquor)

and that I intend to operate a package liquor business at said address of said store, selling and

offering for retail to the public package liquor under the application herein made to the City of

Independence, Missouri, and that I will, at all times, keep in said location at said store a stock of

goods having a value according to my original invoices of at least one thousand dollars ($1,000.00),

exclusive of the inventory value of the fixtures and of the intoxicating liquor, which I shall offer for

sale on said premises.

Applicant

Subscribed and sworn to before me, a Notary Public, this

day of

Notary Public

My Commission expires:

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Parent category: Legal