HomeMy WebLinkAbout1977 Nov 01 - Liquor Renewal Affidavit ��:� � ��s�
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LIQUOR RENEWAL AFFIDAVIT
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� I, Bass River Liquor Store IncorRorated - Richard E Robsham Mgr.
' (individual w+ner, or manager)
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� of Bass River Liquor Stoce
� (name of licensee)
apply for renewal of a Alt Alcoholic
(all alcoholic or wines and malt)
� Package Goods Store
� I (type of license, i .e. restaurant, hotel , club, package store)
i and give oath that this is the same type of license held
during the year 19 77 covering the same license premises
at Jct. Route 28 and Willow St. , So. Yarrtrouth, Mass. 02664
(location of premises)
Manager or Owner� s Name Richard E. Robsham, Mgr.
Home Address: 133 SOUTH STREE"L,BtlSS RIV��R
Home Telephone No. 398-3165 Business No.398-2431
Signed under the pains and penalties of perjury
this FZRSi day of NOV�13i R
1977 .
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! Sign ture of in ividual owne , partner�hipl
' or m nager of t�e corp.
; 3aS5 RIVER LIQCCR S'iORE, I:4CORPORATED
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Note: File in duplicate
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Enc. #1