N.Y. Comp. Codes R. & Regs. tit. 9, § 25.1
(a) The permittee should require every person to whom beer shall be sold for use at such function to file with such permittee a statement as follows:
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)
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: