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¢IT~ OF RAMSE~ <br /> A~LICATION F0~AHUSI2iENT CENTE~ LICENSE <br /> 1988 <br /> <br /> _ ' (State) (ZIP) <br /> (Street, Box', Route) (City~ <br /> <br />3) Bu~ime~ Phone Number(~): ~-- <br /> <br /> (Fi~t ~ame) (Middle Initial) <br /> <br /> 9) if ~rporation, list below the names, residence~ and bir~hdateS of tho~e <br /> owner~ holding more than 5% of the out~tanding stock of the c~rporati~n: <br /> <br /> (Lask Name) (Firs~ Name) (Middle Initial) <br />11) Manager's Date of Birth: ~/ --'~ <br />12) Number of Devices to be Used: _~/m) ~ z' <br />13) Types of Devices to be Used: 1' ~ ~,1 //~'~ ~ <br /> , ~ / <br /> <br />14) Other cities or communities where you've applied for or held a license to <br /> operate a similar type of bu._ne-s. <br /> <br />15) ~ave you, or in the case cf a corporation, the owners cf more than 5% of <br />the outstanding stock of the corporation, beem convicted of a gross misde- <br />- o~ or felo~v~elating <br /> activities? ;~ If yes, e>:Dtain: <br /> <br />27 <br /> <br /> <br />