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m~ve any o£ nbe abow-lis~ed ~erscns been enT~aged in ~ha <br />operatin~ a pa~n shop in the ias~ ~iv~ y~ar.~ :: Yes <br /> <br />If yss, s~ate r~ze and give der~ils. <br /> <br />busLness of <br /> <br />10. <br /> <br />Provide ~$, resid~na~s md/or business addresses of three persms, <br />residents of th~ S~ate of ~Sn~esota of good moral charactmr, not relatad <br />to th~ applicant or financially intmrested in the licensee's who may be <br />referred to ns to tim .applicant's character or, in th~ case where informatim <br />is required of a m~l~ger then also three persor~ of abo%~ descr~.~i(~ for <br />referral conaernin§ said marmger. <br /> <br />Applicant shall provide a statem~t indicating th~ <br />the Applicant has in th~ b~si~ess, bl~Lldi/lg, pi-eu~ses, fixtures, <br />stock in trade, etc. and p~of of source of such ~ey. <br /> <br />FtU, Nam ~ ' '/~ SS/-~' ' ' ~'~.~ ~2X.O <br /> '' ' _ _ ' ' Last Home Phcne <br /> <br /> ~ St~t ' ' S~te ZiP <br /> <br />~ ~~ ~rL N~ ~ A~D ~0~ ~ ~G A~~: <br /> <br /> ~ 1. ~rate S~ ~d ~ ~ ~t of $5,000.00 or ~h b~d <br /> ~ 2. If ~ra~i~, pr~f of ~a~ ~ stated ~ ~ont of <br /> ~ 3. $250.~ ~se/~~ F~ ~ot ~~ ~er or no~ ~d). <br /> <br /> I, t~ ~rsi~ed ~c~t, ~ ~ad ~d ~ly ~~d ~e c~ of <br /> ~r 130.~, of ~ ~ey Ci~ ~ ~lati~ ~ P~ <br /> ~t f~l~ to c~ly ~ ~y of ~e pr~s~s ~~ ~e~ <br /> <br /> ~te ~ ' <br /> <br /> S~d ~d ~m ~ ~fore m, a no~ p~c, ~ ~s' <br /> <br /> ~R ~ ~ ~Y <br />~ ~:' ~"~7' ~~A. ' .... <br /> <br />C. Paid $' Date: .... License No.: <br /> <br /> <br />