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:. If naturalized, state date and place of naturalization ix[/~ <br /> <br />I <br />I <br />I <br />I <br />I <br />! <br /> <br />! <br />I <br /> <br />.:'~i If n0 state the circumstances for each partner who is not a citizen. <br /> <br />Give the full name and address of each officers/shareholder's spouse. <br />Officer/Shareholder Spouse Address <br /> s/~ <br /> <br />Has any one of the officers/shareholders ever used_ or been known by a name other than <br />Ms/her true name? Yes No . ~_ <br />If yes, state what .was such name or names, and information concerning dates and places <br />where used: . .lq ] lq <br /> <br />List occupations each partner has followed fg[ the past fi~,,e_, years? <br /> <br /> Office} - Occupatioh ...... t' ' <br /> <br />I <br />I <br /> <br />Officer Occupation <br /> <br />Officer Occupation <br /> <br />Officer Occupation <br /> <br />Has any one of the officers/shareholders ever been in the military service? <br />Yes No <br />If yes, state which officer~'shareholder(s) <br /> <br />State trade name to be used for the licensed premises: <br /> <br /> <br />