Alcoholic Beverage Retailers Permit Transfer Application Page 5

PERMITTEE CERTIFICATION AND OATH

I, _______________________, certify under penalty of perjury that the

organization applying for this Alcoholic Beverage Retailers Permit does

meet the qualifications of a permittee as described in Sections 67-1-5, 67-

1-51, 67-1-55 and 67-1-69 of the Mississippi Code of 1972, Annotated. I

affirm that this organization will comply fully with the provisions of the

Local Option Alcoholic Beverage Control Laws, Rules and Regulations in

the purchase, sale, and handling of alcoholic beverages and will keep all

records and make all reports and remittances as required thereby. I certify

that the information presented on this application to be true and correct, to

the best of my knowledge and belief.

_____________________

Date __________________

_____________________

(title)

SWORN TO AND SUBSCRIBED before me, this the____day of_____________,____

_______________________

notary public

My commission expires:______________________

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Parent category: Financial