Laserfiche WebLink
AFFIDAVIT CERTIFYING ANNUAL NON INTOXICATING MALT LIQUOR SALES <br /> OF LESS THAN $I0,000 ON-SALE ($20,000 OFF-SALE) <br /> <br />As the licensee for <br /> <br />CASE¥'S GENERAL STORE <br /> <br />(Name of Esmblishment) <br /> <br />14131 SUNFISH LAKE BOULEVARD - RAMSEY, MN <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 />1. That the named licensee's fiscal year last ended prior to this statement began <br /> ~., 199 and ended ., 199__. <br /> <br />2. That during that fiscal year, non intoxicating 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 $ <br /> <br />CASEY'S GENERAL STORES, INC. <br /> <br />(Individual Owner) (Partnership) (Corporation) <br />by S(g~atUre ' ' <br /> <br />CORPORATE SECRETARY <br /> <br /> I <br /> I <br /> I <br /> I <br /> I <br />I' <br /> I <br />I <br />! <br />I <br />I <br /> <br />Title <br /> <br />Subscribed and sworn to before me this <br />l~ars(PubliJ ' ~ ~ <br /> <br />,~Sf'--~ dayof '~~ 1997. I <br /> <br /> <br />