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S'f ATE Of- MINNESU i 4 <br />DEPARTMENT OF PUBLIC. SAFETY <br />LIQUOR CONTROL DIVISION <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" shaD be governed as follows: For a Corpora- <br />tion one officer shall execute this application for 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 `M' UST BCE, ANSWERED.BUSINESS <br />APPLICNTS <br />PHONE UMBER 7 - S7 I -7 HONE NUMBER ME <br />1. I e I C' n-q I'-')r C•'t 4 e ri 1 } <br />(Jndiuidud owner, o5cer, or Wtaer) ~ <br />for and in behalf - +-C ' hereby apply for an Off Sale <br />Intoxicating Liquor License to be located at f / 66 ff i C ,[- ST <br />(Street Address <br />(and/or Lot and Block Number) <br />Municipality of l-t � k e a fi c c: , County of Il C� i'11 S C <br />State of Minnesota, in accordance with the provisions of Minnesota Statutes, Chapter 840, commencing <br />1926, and ending a i,w a 1130 � 191 - <br />2. Give applicants' date of birth <br />Pe (Dev) (Month (Year) <br />Birthdates of Partners 1ts ' 1 J l <br />(Dav) (Month) (Year) <br />3 B A N or <br />- R' ( v1 (Month) (Y J <br />Ofii ;of corporation /�s �j• 4 c <br />(Day) ( oath) Year) S. The residence for each at the applicants aaa fed herein for the past five years is as�ollows- <br />4. Is the applicant a citizen of the United States? J C' S <br />,J <br />If naturalized state date and place of naturalization <br />If a corporation, or partnership, state citizenship status of all officers or partners. <br />cl c of 17. kis <br />6. The person who executes this application shall give wife's or husband's full name and address <br />1, <br />� t' <br />kee n Vannr Ic k-J1 t.ki <br />6. What occupations have applicant•and associates in this application followed for the past five years? <br />rZ,Es - <br />-%,e*k1 r;,0 11 L C:�c- - / /Plilr,t�c <br />7. If a partnership, state name and address of each member of <br />CLERK'S EXHIBIT NO. 3 <br />MEETING-May-10-1978 <br />