A license holder or an employee of the license holder may require an individual to sign a book that the license holder keeps if: the individual has shown documentary evidence that substantiates the individual’s age to allow the purchase of alcoholic beverages; and the age of the individual remains in question. The book authorized under subsection (a) of this section shall contain copies of the following form: Date............... 20.... To Be Filled in by Seller IDENTIFICATION (CHECK ALL SHOWN) DESCRIPTION OF PURCHASER To Be Filled in by Prospective Purchaser I declare I am of legal age to purchase fermented malt beverages or intoxicating liquor, and that I am subject to arrest and prosecution for misrepresenting my age. The license holder or an employee of the license holder shall record all information required by each section of the form. ______________________________________________________________________________ Driver’s license …………………………….. Army I.D. Card ……………………………….. Birth Certificate ………………………….... Coast Guard I.D. Card …………………….... Service Dishcharge ………………………... Marine I.D. Card ……………………………... Draft Card ………………………………….. Navy I.D. Card ………………………………... Air Force I.D. Card ……………………….. Other (Specify) …………………………………………………………………………............. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Height ……………………………………… Weight …………………………………………. Color of Eyes ……………………………… Color of Hair …………………………………... Outstanding Features ………………………………………………………………………….. ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… Seller’s Signature ……………………………………………………………………………….. ______________________________________________________________________________ ______________________________________________________________________________ Print full name ………………………………………………………………………………….. Street Address ………………………………………………………………………………….. City ………………………………………… State …………………………………………… Signature …………………………………………………………………………………………