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a. State whether Ippticant, or any of his associates In this Ippllcation. have e~r ~d en ippli~tion for I iiq~r li~n~ <br /> by any city or State ~ut~ritv; if to, give date and de.ils ,, <br /> <br />Hat the applicant, or any of his associates in this application, during the five years immediately preceding this application <br />had a license under the Minnesota Liquor Control Act revoked for any violation of such laws or local ordinances: if <br /> <br />date and details , , <br /> <br />State whether applicant, or any of his associates in this application, durir~g the Past five years were ever convicted of any <br />Li(luor Law violation or any crime in this state, or any other state, or under Federal Laws; if so, give date and details <br /> <br /> Appl*cant, and his associates in this application, will strictly comply with all the Laws of the State of Minnesota governing the <br />taxation arid the sale of intoxicatinD liquor; rules and regulations promulgated by the Liquor Control Director; and all ordinanc~ <br />of the City; and I hereby certify that I have read the foregoing Cl.p~st~ons and that the answ~s)to said questions are true of my <br /> <br /> Subscribed and sworn to before me this <br /> <br />"~"". day of .-~N~.-,,:\ , ~9.<~.1o. <br /> (Notary Public) <br /> My comm,$$ion expires <br /> <br /> ~.L SUSAN C. MYHEE <br /> '~i"~-' ~'~4~ NOTARy; PUBLIC - ~IN~ESOT <br />~ .... m~ ~mm~ssmn Expires ~a- 2 <br /> <br /> REPORT ON APPLICANT OR APPLICANTS BY POLICE DEPARTMENT <br /> <br /> This is to certify that the applicant, or his associates, named herein have not been convicted within the past five years for <br />violation of Laws of the State of Minnesota, or City Ordinances relating to Intoxicating Liquor, except as hereinafter stated <br /> <br />Approved By: <br /> <br /> ~'~ '~:'~ '7 . POLICE DEPARTMENT <br />(hah-,4 of ¢i~ <br /> <br />Jif you have no ~li~ department, either t~ Mar~al or ~ <br />~nstable ~all ex~e this re~rt on t~ appli~nt.) <br /> <br /> <br />