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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 />837 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 />INDIAN RIVER <br />COU OF _ ••.Gfl.,�MI.... * <br />Peter D. O'Bryan, Chairman <br />APPLICANT SIGNATURE <br />i <br />•,53.2 <br />o! <br />• <br />C <br />'•aNRiVER D �" <br />The foregoing was ( ) Sworn to and Subscribed OR (11 -Acknowledged Before me this ' Day <br />of 1`101tvey.bcr , 20 I'1 , By tit D. d Bcv ilY1 who is (y) -personally <br />( not name(s) of person(s5 making statement) <br />known to me OR ( ) who produced as identification <br />?e-ZN, I U1RA E. VASQUEZ <br />* MY COMMISSION A EE 123140 <br />Commission Expires <br />/ <br />STATE OF FLORIDA <br />INDIAN RIVER COUNTY <br />THIS IS TO CERTIFY T AT THIS IS <br />A TRUE AND CORRE C . ' Y <br />THE ORIGI L 0 <br />OFFICE <br />J <br />SMITH <br />Auth. 61A-3.020 & 61A-5.0017, FAC 6 <br />Eff. 7/30/12 <br />