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AFFIDAVIT CERTIFYING ANNUAL NON INTOXICATING MALT LIQUOR SALES <br /> OF LESS THAN $10,000 ON-SALE ($20,000 OFF-SALE) <br /> <br />(Name of Establishment) <br /> <br />(Address of Establishment) <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 />That the named licensee's fiscal year last ended prior to this statement began <br />. , ,199 and ended ,199__. <br /> <br />That during that fiscal year, non intoxicating malt liquor sales (3.2% beer sales), whether <br />collected for or not, totaled $ <br /> <br />o <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 $. <br /> <br /> [~wn~r)~artn~l~p) ~ <br /> <br />by Sigma' .,7 <br /> <br />Title <br /> <br />I <br />I <br />I <br />I <br /> <br />Subscribed and sworn to before me this day of <br /> <br />No t~D' Public <br /> <br />0 C_."Fo e:,c'-r- I998. <br /> <br />I <br />I <br />I <br /> <br /> <br />