Missouri > Statewide > Alcohol And Tobacco Control
Affidavit Of Lost Permit - Missouri
| Affidavit Of Lost Permit Form. This is a Missouri form and can be used in Alcohol And Tobacco Control Statewide . |
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MISSOURI DEPARTMENT OF PUBLIC SAFETY DIVISION OF ALCOHOL AND TOBACCO CONTROL AFFIDAVIT OF LOST PERMIT NAME OF CORPORATION, SOLE OWNER, PARTNERSHIP, OR LLC DATE LICENSE NO. DOING BUSINESS AS ADDRESS CITY STATE ZIP being first duly sworn upon his her their oath, state(s) that on (MONTH, DAY, YEAR) , there was issued to NAME OF CORPORATION, SOLE OWNER, PARTNERSHIP OR LLC by the Supervisor of Alcohol and Tobacco Control of the State of Missouri, STATE LICENSE NUMBER(S) to sell LICENSE TYPE(S) and that said original license was lost or destroyed on or about and that the circumstances under which the license was lost or destroyed are (MONTH, DAY, YEAR) as follows: , It is therefore requested that a duplicate license be issued in lieu thereof. SIGNATURE OF MANAGING OFFICER, OWNER OR PARTNER DATE SIGNATURE OF PARTNER DATE NOTARY INFORMATION NOTARY PUBLIC EMBOSSER OR BLACK INK RUBBER STAMP SEAL STATE COUNTY (OR CITY OF ST. LOUIS) SUBSCRIBED AN SWORN BEFORE ME, THIS USE RUBBER STAMP IN CLEAR AREA BELOW DAY OF NOTARY PUBLIC SIGNATURE YEAR MY COMMISSION EXPIRES NOTARY PUBLIC NAME (TYPED OR PRINTED) American LegalNet, Inc. www.FormsWorkFlow.com
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