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l) <br /> <br />3) <br /> <br />4) <br /> <br />6) <br /> <br />7) <br /> <br />8) <br /> <br />9) <br /> <br /> CI/"f OF KAMSEY <br /> A~PLICATION FOR AM~S~MENT tEETER LICENSE <br /> 1988 <br /> <br /> (Street, Box', Route)" (Cit~) ' (Sta't~) <br />Hours of Operation: .~/~//~ <br /> <br /> (Last Name) (First Name) <br /> <br />Applicant's Address: /~'//~ <br /> (Street, Box, Route) (~it~) /(State) <br /> <br />Applicant's Date of Bir~h: <br /> <br />Applicant's Position With Company: <br /> <br />%f 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 />(ziP) <br /> <br />(Middle Initial) <br /> <br /> (zip) <br /> <br />10) Manager: <br /> <br />(~Ja~ Name) (Firs~ Name) (Middle Initial) <br /> <br />12) Number of Devices to be Used: ~_%~z~') <br />13) Types of Devices to be Used: /,, , -~ <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 />15) Have you, or in the.case of a corporation, the owners cf more than 5% of <br />the outstanding stock of the corporation, been convicted of a gross misde- <br />meanor or felony~%lating to the operation of amusement centers and related <br /> activities? /~//~z~ if yes, explain: <br /> <br /> <br />