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152 <br /> <br /> AFFIDAVIT CERTIFYING AiNNUAL NON INTOXICATING M.4&,T LIQUOR SALES <br /> OF LESS Tt-L-kN $10,000 ON-SALE ($20,000 OFF-SALE) <br /> <br /> (Name ~f Establish.merit) <br /> <br /> (Address of Establisb_ment) <br /> <br />I hereby state that the 3.2% beer sales were less than $10,000 for the preceding year ($20,000 <br />Off-Sale). <br /> <br />1. That the named licensee's fiscal year last ended prior to this statement began <br /> _, ~:f~ and ended ....~ ~ '~'~ ,200_.2. <br /> <br /> That during that fiscal year, non intoxi~c.a~ing malt liquor sales (3.2% beer sales), whether <br /> collected for or not, totaled $ . ,,~/ <br /> <br /> That during that same fiscal year, purchases of non intoxicating malt liquor (whether paid <br /> for or not during that fiscal year) totaled $ ~/d, ~. <br /> <br /> (Indi~iduai Owner) (P/art~~Corporati0n) <br /> <br /> Title <br /> <br />Subscribed and sworn to before me this <br /> <br />day of 2000. <br /> <br />Notary Public <br /> <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br />I <br />I <br />I <br />I <br />I <br />! <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br /> <br />