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CC_Minutes_2013_1118
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12/17/2013 9:45:31 AM
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11/26/2013 11:00:14 AM
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Roseville City Council
Document Type
Council Minutes
Meeting Date
11/18/2013
Meeting Type
Regular
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Page 11 PLEASE TYPE OR PRINT ALL INFORMATION <br /> STATE ASSIGNED LICENSE NUMBER 0252 44 005 003 AFFIDAVIT <br /> LICENSE PERIOD <br /> APPLIED FOR FROM 2013 TO 2014 DATE: <br /> State of MO r-3101,-id ____ ) <br /> County of /tit()/I1_/GP )/)/7&(—y <br /> ) SS: <br /> As provided by law(R.S. 33:1-35), <br /> (Check One) <br /> 1. The Individual Applicant <br /> 2, Members of the Partnership Applicant <br /> 3 Robert L. Trone of E.G. Holding Corporation Incc <br /> (President/Vice-President) (Corporation or Club Name) <br /> consent(s)that the licensed premises and all portions of the building constituting the licensed premises,including all rooms,cellars,closets, <br /> out-buildings,passageways,vaults,yards,attics and every part of the structure of which the licensed premises are a part and all buildings <br /> used In connection therewith which are in his/her/their possession or under his/her/their control, may be inspected and searched without <br /> warrant,at all hours by the Director of the Division of Alcoholic Beverage Control, his or her duly authorized deputies, inspectors or <br /> investigators and all other sworn law enforcement officers,and being duly sworn according to law,upon his/her/their oath(s),depose(s)and <br /> say(s)that he/she is(they are)the person(s)duly authorized to sign the application,that in instance of corporate ownership,the signator is <br /> authorized by corporate resolution to sign on behalf of the corporations; and that the contents of this application represent complete <br /> disclosure of the fact,and that the contents of this application are true. <br /> (Signature of individual Agent I Sole Proprietor) <br /> (Corporations Only) <br /> Attestation by Corporate Secretary <br /> (Partnership Name) <br /> (Signature of Partner) <br /> Attest: E.g. Holding Corporation Inc. <br /> Corporate Name/ �/0/,/ (Signature of Partner) <br /> By <br /> Secretary ___ (Signature of Corporate President or Vice President) (Signature of Partner) <br /> ?gnat ire <br /> AM"Coiporrts Seal (Signature of Partner) <br /> Sworn to and before me r <br /> this day of/ -—20 l 3 <br /> ��� CHERYL A. COLE <br /> AFFIDAVIT MUST BE SIGNED HERE --► - Sir i / NOTARY PUBLIC <br /> (SiQgnaturre�sfficer Administering Oath) Co uOfl��07/1112015 <br /> BY DULY AUTHORIZED C`��,rLI 19, <br /> , I�LPG <br /> NOTARY PUBLIC (Printed Na of Officer Administering Oath) <br /> OR AN ATTORNEY-AT-LAW -F r'L{ Po f'cam Margla 7—//-2O/ <br /> OF NEW JERSEY (Title of Officer F�ministering Oa t11) (Date of Expiration of <br /> Commission,if applicable) <br />
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