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17. <br /> <br />18. <br /> <br />20. <br /> <br />21. <br /> <br />22. <br /> <br />23. <br /> <br />24. <br /> <br />25. <br /> <br />Has any one of the officers/shareholders, during the past five years, been convicted of any <br />liquor law violations, goss misdemeanor or felony, or any Federal laws. <br />Yes No /~.... If yes, give date and details <br /> <br />Has any one of the officer~/shareholders any interest whatsoever, directly or indirectly, in <br />any other liquor establishment in the State of Minnesota? Yes No ~ If yes, <br />state name and address of each establishment(s). <br /> <br />Furnish the name and address of at least three business references, including one bank <br /> <br />reference. <br />Name / <br />-Name ~'" / ~ _ " Address- .~ C/ ' P...-, //'7-) 'l <br /> <br /> Name ~ Address / I <br /> Do any of the officers/shareholders possess an unexpired retail dealer's identific~ti? card <br /> issued by the Liquor Control Commissioner? Yes No _..,x<:', I <br /> rfyes, give number <br /> <br />Circle wh/cll..!.ic~nse classification the application is being applied for: Exclusive liquor <br />store~ hotel, or club. <br /> <br />If this application is also for a special Sunday license, state the number of guests that may <br />be served food on the premises at any one time. ~ ~ D <br /> <br />Are the premises now occupied, ok' to be occupied, by the applicant entirely separate and <br />exclusive from any other busines~ establishment? Yes ~ No.. ,.~ ~ no, state <br />details about other occupants. <br /> <br />I <br />I <br />I <br />I <br /> <br />Has applicant applied for an on-sale liquor license in co_.nj.unction with any off-sale liquor <br />license for the same premises? Yes No <br /> <br />Give Federal Retail Liquor Dealer's Tax Stamp Numbe.r, if any. <br /> <br />-76- Page 4 of 6 <br /> <br /> <br />