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CITY OF RAMSE¥ <br />APPLICATION FOR AMUSEMENT CENTER LICENSE <br />1988 <br /> <br />1) <br /> <br />2) <br /> <br />~) <br /> <br />4) <br /> <br />5) <br /> <br />6) <br /> <br />FULL Name of Business: ~ ~.,'P <br /> <br /> (Street, Box, Route) (City) (State) (ZIP) <br />Business Phone Number(s): <br /> <br />Hours of Operation: <br /> <br />Applicant: A fz~_.-'~O0-. ~ ~'~'~" <br /> (Last Name) <br /> <br />(First Name) (Middle Initial) <br /> <br />Applicant's Address: 2V¢o,~ ~-',~42.'S/~,. /../~ ~[~f-) ~-z. 5£~' /~.~'S'_~-?~3 <br /> (Street, Box, Route) (City) (State) (ZIP) <br /> <br />7) Applicant's Date of Birth: <br />8) Applicant's Position With Company: ,~'~-~ , , <br /> <br />9) If corporation, list below the names, residences and birthdates of those <br /> owners holding more than 5% of the outstanding stock of the corporation: <br /> <br />i0) Manager: <br /> <br /> (Last l~ame) (First Name) <br /> <br />11) Manager's Date of Birth: <br />12) Number of Devices to be Used: <br /> <br />13) Types of Devices to be Used: ~/~ ~WfzQz_---',, <br /> <br />(Middle Initial) <br /> <br />14) Other cities or communities where you've applied for or held a license to <br /> operate a similar type of business: <br /> <br /> · _/%'0 ~' fJ <br /> <br />15) Have you, or in the case of a corporation, the owners of more than 5% of <br /> the outstanding stock of the corporation, been convicted of a gross misde- <br /> meanor or felony relating to the operation of amusement centers and related <br /> activities? ~ If yes, explain: <br /> <br /> <br />