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17. <br /> <br />Has the applicant, during the five years immediately preceding this application, ever had <br />a liquor license revoked or suspended for any violation of such laws or local ordinances? <br />Yes No X If yes, give date and details <br /> <br />I8. <br /> <br />Has the applicant, during the past five years, been convicted of any liquor law violations <br />gross misdemeanor or felony, or any Federal laws? <br />Yes No X If yes, give date and details <br /> <br />19. <br /> <br />Has the applicant any interest whatsoever, directly or indirectly, <br />establishment in.the State of Minnesota? Yes. )< No ' <br />and address of each establishment(s). <br /> <br />in any other liquor <br />If yes, state name <br /> <br />20. <br /> <br />21. <br /> <br />22. <br /> <br />Furnish the name and address of at least three business references, including one bank <br />reference. <br /> <br />Name <br /> <br />Name <br /> <br />Address <br /> <br />Ad,ess <br /> <br />_Name Address <br /> <br />Does the applicant possess an unexpired retail dealer's identification card issued by the <br />Liquor Control Commissioner? Yes X No If yes, give number G[~-¢g"7 <br /> <br />Are the premises now occupied, or to be occupied, by the applicant entirely separate and <br />exclusive from any other business establishment? Yes X No If no, .state <br />details about other occupants. <br /> <br />23. <br /> <br />Give Federal Retail Liquor Dealer's Tax Stamp Number, if any. /4 l-IC"~ (-//-/d, ff <br /> <br />page 3 of 4 <br /> <br /> <br />