Age Statement Form - CT.gov 2026

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The document is an Age Statement Form from the Connecticut Liquor Control Division, where individuals declare they are over 21 years old to legally purchase alcoholic beverages. It outlines the legal implications of misrepresenting age and includes spaces for personal information such as name, address, and ID details.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date at the top of the form. This should reflect the current date when you are completing the statement.
In the first blank field, write your full name as it appears on your identification.
Next, provide the name of the permittee to whom you are making this age statement.
Fill in your birth date in the designated space, ensuring that it confirms you are over 21 years old.
Indicate your place of birth in the next blank field.
Complete your home address and type of ID in their respective fields.
Finally, enter your ID number to validate your identity before submitting the form.

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