Last updated: 4/5/2007
Representation And Statement Of Age For Purchase Of Alcohoic Beverages
Start Your Free Trial $ 13.99What you get:
- Instant access to fillable Microsoft Word or PDF forms.
- Minimize the risk of using outdated forms and eliminate rejected fillings.
- Largest forms database in the USA with more than 80,000 federal, state and agency forms.
- Download, edit, auto-fill multiple forms at once in MS Word using our Forms Workflow Ribbon
- Trusted by 1,000s of Attorneys and Legal Professionals
Description
REPRESENTATION AND STATEMENT OF AGE FOR PURCHASE OF ALCOHOLIC BEVERAGES I understand that misrepresentation of age to induce the sale, service or delivery of alcoholic beverages to me is cause for my arrest, prosecution and punishment which can result in: 1. payment of a fine not less than $500 nor more than $1,000; possible imprisonment up to 6 months; mandatory loss or deferment of driver's license privileges for 6 months; a requirement to participate in an alcohol education or treatment program for a period not to exceed 6 months. I hereby 2. 3. 4. Knowing the possible penalties for misstatement, represent and state for the purpose of inducing _____________________________________________ (Name of Licensee) _____________________________________________ (Address of Licensed Premises) to sell, serve or deliver alcoholic beverages to me, that I was born ________________________ (Month) ____________________ (Day) ___________ (Year) and I am _________________ years of age. Date_________________________ Signed___________________________ Address___________________________ ___________________________ American LegalNet, Inc. www.FormsWorkflow.com OTHER IDENTIFICATION PRESENTED: Non-Photo Driver's License Number and State _____________________________________________ Photo Driver's License Number and State _____________________________________________ County Photo ID Number and County _____________________________________________ Credit Card Company and Number _____________________________________________ Draft Registration Number and Date _____________________________________________ Other Specify _____________________________________________ Signature of person who witnessed completion of this statement by patron. ____________________________________________ (Signature) State of New Jersey Department of Law and Public Safety Division of Alcoholic Beverage Control 140 East Front Street, P.O Box 087 Trenton, NJ 08625-0087 07/03 American LegalNet, Inc. www.FormsWorkflow.com
