Inflatable Amusement Device Affirmation - Nyc Department Of Consumer Affairs
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142 Broadway
INFLATABLE AMUSEMENT DEVICE
New York, NY 10004
AFFIRMATION
Dial 311
(212-NEW-YORK)
nyc.gov/dca
Legal Name of Business:
Business’s Trade or
Doing-Business-As (DBA)
Name, if applicable:
Business Address:
I affirm that my business will operate the inflatable amusement device
in compliance with the manufacturer’s requirements and instructions,
which include tying down the device securely and properly.
I understand that falsification of any statement made herein is an
offense punishable by a fine or imprisonment or both.
_________________________
_____________________
Signature
Print Name
_________________________
_____________________
Title/Position (if any)
Date
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