Consent Affidavit - City Of Independence, Missouri Finance Department printable pdf download

Consent Affidavit - City Of Independence, Missouri Finance Department

CITY OF INDEPENDENCE, MISSOURI

Finance Department - License Division

111 East Maple

Independence, Missouri 64050

816-325-7079

CONSENT AFFIDAVIT

Date

, attest that consent is hereby given

(Name of Consenting Party)

to the Liquor License Officer of Independence, Missouri, to issue a

license to:

(Specify Classification of Liquor License Applied For)

Applicant Name and Address of Premises Proposed To Be Licensed:

Applicant Name

Business Name

Business Address

I reside at

Telephone No.

My business address is

Telephone No.

I understand that before such a permit may be issued, my consent may be required because I am the owner

the property located at

which property is within 300 feet of the premises proposed to be licensed.

I am furnishing this consent only for the type of license indicated above. Prior to any other type of license

being

issued, I understand that another consent would be necessary.

Signature of Consenting Party

Subscribed and sworn to before me this

day of

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Consent Affidavit - City Of Independence, Missouri Finance Department