Rev-656 - Application For License To Resell Amusement Tickets Page 2
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1
2CERTIFICATION AND SIGNATURES
I certify that the information, including accompanying statements, is, to the best of my knowledge and belief, true, correct
and complete.
NDIVIDUALS
I
Please sign these lines after printing
(APPLICANT’S SIGNATURE)
(PRINT NAME AS IT APPEARS ABOVE)
CORPORATIONS
(Corporate Seal)
ATTEST
BY
SECRETARY OR TREASURER
PRESIDENT OR VICE-PRESIDENT
PARTNERSHIPS OR ASSOCIATIONS
WITNESSES
(SEAL)
(SEAL)
(SEAL)
(SEAL)
NOTARIZATION
Subscribed and sworn to before me this day of
, 20
My commission expires
, 20
(SIGNATURE IN INK OF PERSON ADMINISTERING OATH)
(ADDRESS OF PERSON ADMINISTERING OATH)
RETURN TO PAGE ONE
PRINT
RESET FORM
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Parent category: Business