New Hampshire > Statewide > Liquor Commission
Affidavit - New Hampshire
| Affidavit Form. This is a New Hampshire form and can be used in Liquor Commission Statewide . |
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State of New Hampshire Liquor Commission Division of Enforcement & Licensing AFFIDAVIT This affidavit is filed with the Liquor Commission's Division of Enforcement & Licensing in support of my ownership, management control, employment by a business licensed, or applying for a license to sell alcoholic beverages and tobacco under Chapter 178 of the Revised Statutes Annotated. I, (Print Name) being duly sworn do depose and say: Business Trade Name: Address (No. Street) 1. Liquor Lic# (City / Town) (State) (Zip) Mailing Address (No. Street) (City / Town) (City / Town) on (State) (State) (Zip) (Zip) (Age) 2. 3. I live at: (No. Street) I was born in (POB: i.e. State, or Province if Canada, Country if foreign) (Date of Birth) Home phone 4. I am Male I am not a citizen of the United States Female Race Soc. Sec # If not a citizen, R.A. Document # or other Identification submitted 5. I understand RSA 178:4 & RSA 179:23, IV, prohibit convicted felons from holding a license to sell alcohol or assuming control of licensed premise. By signing this affidavit I swear this information is true and accurate and that this document is signed under the penalty if false swearing (RSA 641:2) Have you ever been charged with a crime? If yes, were you convicted of a felony? Yes Yes No No 6. 7. I am filing this document in support of my employment as a Corporate Officer Partner LLC Manager POA LLC Member Manager Person in Charge Proprietor Title/Position RSA 179:23, IV requires the licensee to designate one or more people to be in charge of the premise in the licensee' absence. 8. I swear before the Justice of Peace or Notary Public that this information is true and accurate, and that this document is signed under the penalty if false swearing (RSA 641:2) Date SS. (Affiant Name) Signature County Personally appeared before me and made oath that the same is true. SEAL L-002 (Reviewed 8/8/2012) Date: known to be the person who executed Justice of Peace / Notary Public 8/2006 American LegalNet, Inc. www.FormsWorkFlow.com
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