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Are each of the.o£ficers and/or shareholders citizens of the United States? <br />Yes'~ No <br />[fnamralized, state date and place of naturalization ///,4'.. <br /> <br />I <br />I <br />I <br /> <br />If no, state the circumstances for each partner who is not a citizen. <br /> <br /> Give the full name and address of each officer's/shareholder's spouse. <br />Officer/SharehoJder ^ vc"~Spfouse . .,~r') Address <br />· [L~0r4~~'~' ~ 9:4~~' <br /> <br />Has any one of the officers/shareholders ever used....--°r been known by a name other than <br />his/her true name? Yes No . <br />If yes, state what was such name or names, and information concerning dates and places <br />where used: . ,4//7. <br /> <br />I <br />! <br />I <br />I <br />I <br /> <br />o <br /> <br />Lis occupations~each partner has followed for.the past five yea)s?, <br /> Officer '//...eL): i'h~''0~ ) Occupation <br /> <br />OffrMr <br /> <br />Occupation <br />Occupation <br />Occupation <br /> <br />Has any one of the officers/shareholders ever been in the military service? <br />Yes No X . . <br />If yes, state which officer/shareholder(s) <br /> <br />State trade name to be used for the licensed premises: <br /> <br />I <br /> <br />I <br />I <br />I <br />! <br />I <br />I <br /> <br />-176- <br /> <br />Page 2 of 6 <br /> <br />I <br />I <br /> <br /> <br />