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JVN-~?-~00~ 18~00 <br /> <br />-186- <br /> <br />.3. <br /> <br />-5. <br /> <br />, 6. <br /> <br />Michael J. Tgzier <br />Jef~re7 C. Hu_ltgr, e~ <br /> <br />Tom Ro~en <br /> <br />If no, state the circumstances for ~ach psrrller who i~ not a citizen. <br /> <br />Giw the full name and addrezs of each ~ ....~ .... % spouse. <br /> Spouse Addre~ <br /> <br />I-ha any one of the ~s ever used or bema known by a name other t...h~n <br />his/her true name? Yea: No <br />If yes, ~tate what w~s ~uch name or names, and information concerning dams and places <br />where u~ed: <br /> <br />List occupadon~eachtmla~hasfollowedforthc paltfiv~ years? <br />Michael J. Tozier , .~-~~ _,,~.~..... I <br /> Officer Occupation <br /> m <br /> <br />Jeffrey C. ~u%cKren._ __ <br /> Officer <br /> <br />Occupation <br /> <br />Officer Occup~ti~ <br /> <br /> Officer Occupation <br /> <br /> M~ag~O/Me~b, ers <br />Has any one of the ...... ~-'~- ~ever been in the military ~ervice? <br />Yes X _._ No' ~ <br />If yes"state which oh%e~/~hareholder($) uY't~r-~,t~ ~4.rr_.~oJ' <br /> ! <br /> <br />m <br /> <br />m <br />m <br />m <br /> <br />State trade name to be Used for the licensed premises: <br /> <br />m <br /> <br />Page 2 of 6 <br /> <br />m <br />m <br />m <br /> <br /> <br />