FORM L-D (1/2020)
STATE OF TEXAS
BEFORE ME, the undersigned authority, on this day personally appeared
, credible person(s), and
Name of Applicant
who after being by me duly sworn did depose and say:
Applicant or applicants hereby certify that the diagram of the premises attached
at is a fair
and accurate representation of the subject in question as it exists on the date of this
application and is a part of this application. I also certify that this diagram will be posted
with my license/permit.
Printed Name of Applicant
Signature of Applicant
Subscribed and sworn before me, this day of , 20 .
Signature of Notary