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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 />As thelicensee for ~Or ~P <br /> <br />(Nm'ne of Establishment) <br /> <br />(Address of Establishment) <br /> <br />I heresy irate that the 3.2% beer sales were less than $10,000 for the preceding year ($20,000 <br />Off-Sa!e). <br /> <br /> That the named licensee's fiscal year last ended prior to this statement began ', ,199 ..... and ended - ., 199_. <br /> <br />i'That during that fiscal year, non intoxicating malt liquor sales (3.2% beer sales), whether <br />collected for or not, totaled $ <br /> <br />iiThat during that same fiscal year, purchases of non intoxicating malt liquor (whether paid <br />~:for or not during that fiscal year) totaled $ 0~.to ' . <br /> <br />(Individual Owner) (Partnership) (Corporation) <br />by S i gn-~"~c <br /> <br />Title <br /> <br />Subscribed ,and sworn to before me this <br /> <br />Notary i%blic / <br /> <br />day of. 199;t. <br /> <br /> [~ ~ COLLEEN C. RYBAK ~ <br /> ~'~ I."~ NOT,~¥PU~JC-MINNESOTA ~ <br /> <br /> <br />