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STATE OF MINNESOTA <br />DEPARTMENT OF PUBLIC SAFETY <br />LIQUOR CONTROL DIVISION <br />DPS 9136 (10-75) <br />APPLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE <br />This application and the bond shall be submitted in duplicate <br />Whoever shall 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 "APPLICANTS" shall be governed as follows: For a Corpora- <br />tion one officer shall execute this application far all officers, directors and stockholders. For a partnership <br />one of the "APPLICANTS" shall execute this application for all members of the partnership. <br />EVERY QUESTION MUST BE ANSWERED. <br />BUSINESS y <br />� S1. 1 7 APPLICANT'S HOME <br />PHONE NUMBER PHONE NUMBER r 9001 <br />L I,PZas <br />+rr► <br />(Individual owner, officer, or partner) <br />. , <br />for and in behalf of1t 13 ! 9 S 2/y C• , hereby apply for an Off Sale <br />Intoxicating Liquor License to be located a <br />(Street Address and/c-r Lot and Bloch Number) <br />Municipality of County off <br />State of Minnesota, in accordance .with the provisions of Minnesota Statutes, Chapte 310, commencing <br />ar <br />19n, and ending -- <br />Give applicants' date of birth <br />Pets r (Day) (Month) !Year) <br />Birt.hdates of Partners Inn- ,� �� ` 1P J 0 — <br />(Day) (Month) (Year) <br />or J4 <br />; DrA <br />jDay) (Month (Year) <br />AA <br />Officers of Corporation Axwx A 6 <br />(Day) (Month) (Year) <br />3. The residence for each of the applicants named herein for the past five years is as& folio VS: Z.4 �. <br />- P-11 1- e- it 4 4e k q r <br />AL BEA T 1*3 <br />4. Is the applicant a citizen of the United States? <br />If naturalized state date and place of naturalization_.. <br />If a corporation, or partnership, state citizenship status of all officers or partners. <br />A 4 <br />♦'�•�s <br />5. The person who executes this application shall give wife's or husband's Zname and address_. <br />• AO AFA ow <br />C e v, or PP AP 0 IF 078S am"m06 <br />6. What o cupations have applicant and associates in this application fol?owed for the past five years' <br />0 - . --1-0 - - - r--* d A .. a (1 . JL i <br />ow <br />�7. If a partnership, state name and address of each member of partner -'- ,•- <br />Clerk's exhibit no. 384 <br />Meeting 4-14-76 <br />