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' STATE OF MINNESOTA s <br />UEO OF PUBLIC S <br />LIQUOR ? <br />I <br />' LIQUOR CONTROL DIVISION ION A <br />APPLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE <br />Whoever shell knowingly and wilfully falsify the answers to the following questionnaire shall be <br />deemed guilty of perjury and shall be punished accordingly. <br />In answering the following questions "APPLICA shall be governed ee follows: For a Corpora. <br />lion one officer shall execute this application for ell officers, directors and stockholders. For a partnership <br />one of the "APPLICANT'S" shall execute this application for all members of the partnership. <br />EVERY QUESTION MUST RE ANSWERED. <br />BUSINESS APPLICANT'S HOME <br />PHONE NUMBER ?Z'7- 99 28 PHONE NUMBER <br />1. I - P -0k"6E '1 .1n11 E /'/III_ L Pnx a ?I y . <br />(Inemdual owner, olhur, or perrneQ <br />for and In behalf o M V C E L F <br />hereby apply for an OR sale <br />S <br />Intoxicating Liquor License to be located et�2(_,� —f4 <br />(Srurt Ae reu and /or Lot and al.h Nambrr) <br />Municipality of AM E �/ County of A TI (2 //A4 <br />State of Minnesota, In accordance with the provisions of Minnesota Statutes, Chapter 340, commen <br />19_, and ending pir A/01N6 PP1?ayq[ <br />2. Give applicants' date of birt 7 -5F-P <br />(D ay) (Month) lYraq <br />Bitthdates of Partners Al n' <br />(Dv) (Month) <br />or „ (Yrar) <br />(Day) (Ymr) <br />Officers of Corporation ( Monrh) <br />(Dv) (Month) (Y.,) <br />3. The residence for each of the applicants named herein for the past five years is m follows: <br />lbBrth /Qtv A/ Ln/ AA7?�FbL n „ <br />4. Is the applicant a citizen of the United States <br />If naturalized state date and place of naturalizatior` <br />If a corporation, or partnership, state citizenship status of all officers or partners. <br />6. The person who executes this application shall give wife's or husband's >Q r. i full name and add <br />o Al(VI fj <br />A IAir, Ge) `a!) _ /E�BZ`L t .1� ICfA c f//(A , v <br />6. What occupations have applicant and associates In this application followed for the past past five years ?_ <br />W AIZON1 OIL C I O — 747 `14 EedQL2 eoa,D �T Pa - /y Vi ?S <br />- 4 <br />2 <br />7. If a partnership, state name and address of each member of partnership N 4. <br />