Connecticut Gen. Stat. § 30-86

Age statement

144 Temple keeps an electronic age statement on file for every guest whose age is in question. Fill this in once, sign it, and it applies to this purchase and every future purchase at these premises.

First nameLast nameDate of birthPlace of birthStreet addressApt / unit (optional)CityStateZIPMobileEmail

ID typeLast 4 of ID numberID expires

Photo of your ID

Front of your license, ID card or passport. Make sure the name, photo and date of birth are readable.

No photo yet

Photo of you

A quick photo of your face so staff can match it to the ID.

No photo yet

The statement

August 22, 2026

I, ................, hereby represent to 144 Temple, a permittee of the Connecticut Department of Consumer Protection, that I am over the age of 21 years, having been born on ................, at ................. This statement is made to induce said permittee to sell or otherwise furnish alcoholic beverages to the undersigned. I understand that title 30 of the general statutes prohibits the sale of alcoholic liquor to any person who is not twenty-one years of age.

I understand that I am subject to a fine of one hundred dollars for the first offense and not more than two hundred fifty dollars for each subsequent offense for wilfully misrepresenting my age for the purposes set forth in this statement.

................ (Name)

................ (Address)

Signature

Sign above with your finger or mouse.

I have read the statement above, everything I entered is true, and I understand a false statement carries a fine of up to $100 for a first offense and up to $250 for each later offense.

21+ · Kept on file for Department of Consumer Protection inspection

Age statement

Your details

ID details

ID verification

The statement