All corporations/organizations or limited liability companies applying for a license to sell fermented malt beverages and/or intoxicating liquor must appoint an agent. The following questions must be answered by the agent. The appointment must be signed by an officer of the corporation/organization or one member/manager of a limited liability company and the recommendation made by the poper local official.
Any person who knowingly provides materially false information in an application for a license may be required to forfeit not more than $1,000.
ACCEPTANCE BY AGENT
I hereby accept this appointment as agent for the corporation/organization/limited liability company and assume full responsibility for the conduct of all business relative to alcohol beverages conducted on the premises for the corporation/organization/limited liability company.
APPROVAL OF AGENT BY MUNICIPAL AUTHORITY
(clerk cannot sign on behalf of Municipal Official)
I hereby certify that I have checked municipal and state criminal records. To the best of my knowledge, with the available infomation, the character, record and reputation are satisfactory and I have no objection to the agent appointed.