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STATE OF MINNESOTA ors alas (10-751 <br />DEPARTMENT OF PUBLIC SAFETY <br />LIQUOR CONTROL MVISION <br />AIIIILII:ATION FOR UF1' SALE 1NTOX1l NrING 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 shail be punished accordingly. <br />In answering the following questions "APPLICANT'S" shall be governed as follows: For a Corpora. <br />tion -no officer shall execute this application for all officers, directors and stockholders. For a partnership <br />one •APPLICANTS" shall execute this application for all members of the partnership. <br />RY QUESTION MUST BE ANSWERED. <br />BUSINESS APPLICANT'S HOME <br />PHONE NUMBER H.4'�/ /.� /G n PHONE NUMBER 17 7-2 2 <br />1. I- .-L����c <br />, <br />(Individual owner. o4cer, or partner) <br />for and in behalf o , hereby apply for an Off Sale <br />Intoxicating Liquor License to be located at -2 i.2 tr �— <br />. <br />� /( (Street Addreae and/or Lot and Block Number) <br />Municipality ef�i±'� `������ �-- , County of <br />State of Minnesota, to accordance with the provisions of Minnesota Statutes, 46hapter $40. commencing <br />1 , 19-ZZand ending <br />2. GIve applicants' date of birth `Z�e• c /Z <br />(Day) (Month) (Year) <br />Btrtbdates of Partners Jy J,4 y9 <br />(Day) (Month) (year) <br />or /9 C se <br />(Loy) (Month) (year) <br />Officers of Corporation .?/ r cr� <br />(Day) (Month) (Year) <br />The residence for each of the applicants named herein for the past five years Is as follows: <br />4. Is the applicant a citizen of the United States? <br />If naturalized state date and place of naturalization <br />U a corporation, or partnership. state citizenship status of all officers or partners. <br />The person who executes this application shall give wife's or husbaannd's full name and addrean <br />What occupations have applicant and associates in this application followed for the past five years? <br />If a partnership, state name and address of each member of partne <br />CIERK'S EXHIBIT ND. 1089 <br />Meeting-5-11-77 <br />