Kentucky > Statewide > Alcohol Beverage Control > Miscellaneous
Self Certification For Compliance - Kentucky
| Self Certification For Compliance Form. This is a Kentucky form and can be used in Miscellaneous Alcohol Beverage Control Statewide . |
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ABC Edu. Fin. Asst. Self-Certification 12/20/05 SELF-CERTIFICATION FOR COMPLIANCE WITH KRS 164.772 Default in repayment obligation under financial assistance program Professional licensing and certification Notification. This form must be completed (signed and dated) by all persons interested in this application, including, but not limited to, officers, partners, and managing members. If this involves more than one person, make copies in order that each such interested person completes this form. Certification of Repayment of Educational Financial Assistance I, _______________________________________________, am an applicant for a license related to alcohol or alcoholic beverages issued by the Kentucky Office of Alcoholic Beverage Control. I hereby certify that I am not in default of a repayment obligation, such as a student loan repayment, under any financial program administered by the Kentucky Higher Education Assistance Authority (KHEAA). ________________________________________ Signature of applicant _____________________ Date RETURN THIS COMPLETED FORM TO STATE ABC ALONG WITH YOUR APPLICATION American LegalNet, Inc. www.FormsWorkflow.com
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