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Affidavit (Cash Law - Malt Beverages) C-809 - Texas

Affidavit (Cash Law - Malt Beverages) Form. This is a Texas form and can be used in Alcoholic Beverage Commission Statewide .
 Fillable pdf Last Modified 12/17/2010
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FORM C-809 (08/2010) STATE OF TEXAS COUNTY OF ___________________________ AFFIDAVIT (CASH LAW ­ MALT BEVERAGES) BEFORE ME, the undersigned authority, this day personally appeared ___________________________________, who is a credible person, and who, after being by me duly sworn, did depose and say: That, the following financial instrument(s) were received by _______________________________________________ on (Manufacturer or Distributor Permittee) the date(s) shown as payment(s) for alcoholic beverage malt beverage products delivered to ____________________________________________________, permit/license number ___________________, located (Retailer, Mixed Beverage or Private Club Permittee) at ____________________________________________, ___________________, Texas. (Physical Street Address) (City) Instrument NO. Instrument Date Instrument Amount _____________ ______________ _________________ _____________ ______________ _________________ _____________ ______________ _________________ _____________ ______________ _________________ _____________ ______________ _________________ _____________ ______________ _________________ _____________ ______________ _________________ _____________ ______________ _________________ _____________ ______________ _________________ That: said financial instruments were dishonored by the financial institutions noted on the attached checks, returned to the payee, and were subsequently reported to the Texas Alcoholic Beverage Commission as violations of cash law. (TABC Code 102.31 & Rule 45.131) ___________________________________________________ Manufacturer or Distributor Permittee ___________________________________________________ Address ______________________________(____)________________ Permit Number Phone No. (Notary Seal) ___________________________________________________ Representative's Signature Title SWORN TO AND SUBSCRIBED BEFORE ME, the undersigned authority, this _____ day of ____________,_______. ___________________________________________________ Notary Public in and for the State of Texas 1 American LegalNet, Inc. www.FormsWorkFlow.com
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