13.07.2015 Views

Cobb County Business License Division P.O. Box 649 Marietta ...

Cobb County Business License Division P.O. Box 649 Marietta ...

Cobb County Business License Division P.O. Box 649 Marietta ...

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<strong>Cobb</strong> <strong>County</strong> <strong>Business</strong> <strong>License</strong> <strong>Division</strong> 39Alcoholic Beverage Establishment Change of <strong>License</strong>e ApplicationRevised 1/09<strong>Cobb</strong> <strong>County</strong> Alcoholic Beverage and <strong>Business</strong> <strong>License</strong>Fingerprint AffidavitBy executing this affidavit under oath, as an applicant for a <strong>Cobb</strong> <strong>County</strong> Alcoholic Beverage and <strong>Business</strong> <strong>License</strong>for_______________________ (name of business) I _____________________________ (name of applicant) have submitted fingerprints to the Georgia Bureau of Investigation through GAPS in compliance with O.C.G.A 3-3-2.In making the above representation under oath, I understand that any person who knowingly and willfully makes a false,fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of Code Section 16-10-20 of theOfficial Code of Georgia._____________________________Signature of Applicant_____________________________Date_____________________________Printed NameSUBSCRIBED AND SWORNBEFORE ME ON THIS THE____ DAY OF ____________, 20_______________________________Notary PublicMy Commission Expires:_____________________________

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