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1.7.,E, OTA JOIYT 1=-. ER 77F..77.‘i C- C rICN <br />PLCI•FEER P.O. eF,OdC. 1.760 <br />sr LIT ; <br />CC-552 II OR (5ft <br />A.FFLICA.:7101.\47 FOR LIQUOR LI-k/birTY COVERACE <br />3reacitzt. :Jar:cent wsinari ejeccn. CrILI tiCZ2-3; and <br />cr-o- -dor attae-^ed. Cc.---erge -or mot be bond -21-tor <br />ALL---*,:1/4n:er. <br />• <br />Cdiiscage, WL :Ict C Ocattd <br />'4,'C'nn'-'n`n:n7 of iiccr <br />am. :dee: day icii-e•Adag :toe_it.-c cE zide acc <br />Leasi Name of Applicant <br />Trade Name <br />ivhiling Address 6( 3— Cf- Zifttle Ctilqa-adfL5c tA <br />Corporation X Non-Profit <br />; <br />Individual Pnrship <br />If Applicant is Individual: <br />Applicant Name Agsi <br />If Applicant is a Partnership or Carp-oration: <br />Name of Each Palmer or <br />'R ( LC /5 05,5 - <br />f3o.rt b .5 g c._i.v. - <br />7 . <br />Other <br />Spouse Name <br />Operating, Location(s) - List. all Locations: <br />I. 5e-oo-A.e-c- Pc-vq.K 35t g 4 c4 <br />1.1 d-J int) ir;-7/2 <br />Classification <br />Primary Nature of Business: <br />Percentage of Ownership <br />/044- <br />14//4 <br />• /V/A <br />Check all applicable_ <br />I_ Restaurant 2- Club <br />4. _Bowling Alley 5, On/Off Sales <br />7. )4 Sp=ial Event <br />Total Gross Receipts of Entire Establishment <br />Grass Receipts from Liquor Sales Included Above <br />7- ")t i e-po <br />000 <br />3. Bar <br />6. Off, Sale Only <br />3, ° Q <br />rS.rw. <br />Searing Capacity Total Bar Only <br />License in. Effect? Yes ,_Na <br />Licensing Authority <br />Address <br />License Number <br />Effective Date Enfiration. Date <br />Licse Ever RevolcedjSusneuded? Yes No If yes, dare <br />If yes, explain <br />for SW 7 <br />