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STATE OF MINNESOTA <br /> DEPARTMENT OF PUBLIC SAFETY <br /> LIQUOR CONTROL DIVISION <br /> AI'PLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE <br /> This application and thc bond shah be submitted in duplicate <br /> V,q~oever shall knowingly and wilfully falsify the answers to the follow[ag questionnaire shall be <br />iemed guilty of perjury and shall be punished accordingly. <br /> <br /> In answering the following questions "APPLICANTS" shall be governed aa follows: For a Corpora. <br /> ,n one o~cer shall execute 1his application for all officers, directors and stockholders. For a paxtnership <br /> one of the "APPLICANTS" shall execute this application for all members of the partnership. <br /> <br />IEVERY QUESTION blUST HE ANSWERED. <br /> JS1NESS ri,4' .~ ._ _~ ~qq APPLICANT'S HOME <br /> tONE NUMBER r~J '~'~--/ PHONE NUMBER qo~[-~¢~ 7 <br /> <br /> (Indiuid~a! otUner, o~ce,r, or partner) <br />land in behalf of /27_ ht /~__/- 25~: e/p,- p .,~/UC . hereby apply for an Off Sale <br /> <br /> Intoxicating Liquor License to be located at ~,.f/._5_/~ ) ?),z~,,~' ,P,oe.2, <br /> (Sitter Addrezs csnd/or Lol and Biota <br />Imictpality of J~,q ~ $ c~a , County of /~,g.j~,,~c{ , <br />State of l%~inncsota, in accordance wlth the provisions of Minnesota Statutes, Chapter 340, commencing <br /> <br />I Give applicaqts' date of birth .~ /g:7/~/~ )// / <br /> (Day) ~'(Month) (Year) <br /> <br />I (Day) (Month) <br /> O~ <br /> fMonlh) (Year) <br /> <br /> Officers of Corporation <br /> (Da~) (Month) (Year) <br /> <br /> The resMence for each of the applicants named here~n for ~he.paa[ five year$ ~s as follows: <br /> <br />Is the applicant a citizen of the United States ? ../~' _5' <br /> <br />H a corporation, or partnership, state citizenship status of all officers or partners. <br /> <br />I The person who executes this application shall give wife's or husband's full name and address <br /> <br />What occupations have applicant and associates In thls application followed for the past five years?~ <br /> <br /> 7. If a partrership, state name and address of each member of partnership <br />! <br /> <br /> <br />