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AJe each of the or, cars and/or shareholders ckizens of ~he Unked S~.mtes? <br />Yes /~ . No <br />If naturalized, state date and place of naturalization <br /> <br />If no, state the circumstances for each partner who is not a citizen. <br /> <br />4. Give the full name and address of each officer's/shareholder's spouse. <br /> ©fficer/Shareholder Spouse A. ddress <br /> <br />5. :~ ~y one of the offlcers/sh~eholders ever used o'r been ~own by g name o~he: th~ <br /> hisser tree n~e? Yes No .~ <br /> If yes, state what w~ such n~e o: names, ~d info.salon concemin~ dates and places <br /> where used: .:~/~ <br /> <br />List occupations each 'partner has followed for the past five years? <br /> <br />(ffccupation <br />Occupation <br /> <br />Occupation <br /> . ./? <br />Occupation <br /> <br />Has any one of the officers/shareholders ever been in the military service? <br />Yes No 3C , <br />If yes, state which officer/shareholder(s) <br /> <br />8. State trade name to be used for the licensed premises: <br /> <br />I <br />I <br />I <br /> <br />Page 2 of 6 <br /> <br />.69 <br /> <br /> <br />