Application For Brewer'S To Sell Beer For Off-Premises - New York Liquor Authority (Page 2 of 2) in pdf

Application For Brewer'S To Sell Beer For Off-Premises - New York Liquor Authority Page 2

SECTION C

THE FOLLOWING CERTIFICATION MUST BE SIGNED AND DATED BY AN INDIVIDUAL LICENSEE AND EACH

MEMBER OF A LICENSED PARTNERSHIP

The undersigned, each for themselves, certifies that he/she is the applicant above named; that he/she knows the contents of the above

application and the statements contained therein and the same are true of his/her own knowledge.

Dated__________________________________________

________________________________________________________

(Signature of applicant or of each partner)

THIS CERTIFICATION TO BE SIGNED AND DATED WHEN THE LICENSEE IS A CORPORATION

___________________________________________________, certifies that he/she is____________________________________________

(Title)

of the above named applicant corporation; that he/she knows the contents of the above application and the statements and answers therein; that

the same are true of his/her own knowledge; that he/she has been authorized, by order of the Board of Directors of said applicant corporation to

make the statements and answers in this application in behalf of said applicant corporation with the same force and effect as if said corporation

made such statements and answers itself.

Dated __________________________________________

________________________________________________________

(Signature of authorized officer)

Completed applications and any supporting information should be mailed to:

NEW YORK STATE LIQUOR AUTHORITY

PO BOX 3796

NEW YORK, NY 10008-3796

Brewer Off-Premises Permit (3/25/11)

Application For Brewer'S To Sell Beer For Off-Premises - New York Liquor Authority Page 2