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SECTION 8-AFFIDAVIT OF APPLICANT <br /> NOTARIZATION REQUIRED <br /> Business Name(D/B/A) <br /> BOARD OF COUNTY COMMISSION OF INDIAN RIVER COUNTY <br /> "I, the undersigned individually, or if a registered legal entity for itself and its related parties, hereby swear or <br /> affirm that I am duly authorized to make the above and foregoing application and, as such, I hereby swear or <br /> affirm that the attached sketch is a true and correct representation of the premises to be licensed and agree <br /> that the place of business, if licensed, may be inspected and searched during business hours or at any time <br /> business is being conducted on the premises without a search warrant by officers of the Division of Alcoholic <br /> Beverages and Tobacco, the Sheriff, his Deputies, and Police Officers for the purposes of determining <br /> compliance with the beverage and retail tobacco laws." <br /> "I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45 and <br /> 1837.06, Florida Statutes, that the foregoing information is true and that no other person or entity except as <br /> indicated herein has an interest in the alcoholic beverage license and/or tobacco permit, and all of the above <br /> listed persons or entities meet the qualifications necessary to hold an interest in the alcoholic beverage license <br /> and/or tobacco permit." <br /> STATE OF FLORIDA <br /> COU OF INDIAN RIVER <br /> .•''•�1MIS '• <br /> C AG0 OAF <br /> ��` /� row •9s*. <br /> APPLICANT SIGNATURE ; <br /> : <br /> Peter D. O'Bryan, Chairman y,;•., <br /> APPLICANT SIGNATURE •. N'''•� -''rt•,•••• <br /> • ��•.R/VEfl C0��•. <br /> The foregoing was ( ) Sworn to and Subscribed OR (Acknowledged Before me this Day <br /> t <br /> of lfelnn�,f 20 7 By:pp— of�. 0 f�1�1 on who is (y, -personally <br /> ( rint name(s) of person(s making statement) <br /> known to me OR ( ) who produced as identification. <br /> LAURA E VASCIUEZ <br /> * * MY COMMISSION A EE 123140 n <br /> Commission Expires: U oQo/S <br /> N u b I is '+� ��' Bonded TM eu*NoWy Sw*a <br /> STATE OF FLORIDA .•"'�ppIERS• '" <br /> INDIAN RIVER COUNTY •"•�S`'.•••••• ...•.'f ''+ <br /> THIS IS TO CERTIFY T AT THIS IS r=V�r' •'.:o`; <br /> A TRUE AND CORRE C Y <br /> THE ORIt31 L O T IS t;; <br /> OFFICE. <br /> J SMITH <br /> DATE `�' ... <br /> ... X <br /> Auth.61A-3.020&61A-5.0017,FAC 6 Eff. 7/30/12 <br />