A brewer or a beer wholesaler to whom an annual beer function permit has been issued under subdivision 2 of section 97 [Alcoholic Beverage Control Law] shall exercise the privileges conferred by such permit only under the following conditions:
Invoice No. ____________
I,
__________
(Name) residing at
(Residence)
________ state that I am the (person) (authorized representative of the organization) who is purchasing
(Amount) cases barrels of beer from
(Name of Permittee) (Permit No.) for consumption at a function to be held on
____________
(Month)
(Day)
(Year)
by
__________
(Name and Address of Organization) at
____________
(Location where function is to be held)
and further that the beer is to be purchased for consumption only, at said function, and not for resale; that the general public will not be admitted to said function; and that admission thereto is not contingent upon the payment of an admission fee, contribution or donation of any kind.
I understand that this statement will be accepted for all purposes as the equivalent of an affidavit and if false will subject me to the same penalties as if I had been duly sworn.
______________
(Signature and Office in Organization)
Dated
(Residence Address)
N.Y. Comp. Codes R. & Regs. Tit. 9 § 25.1