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11. If this is a transfer application give rime, address, of persons, partnership or <br />corporation holding license for the pas: year. <br />Thomas Allen Duray <br />12. Who owns the tavern fixtures? <br />13. What vending or mechanical amusement device company has or will have mac-ines on <br />the licensed premise? <br />Theisen Music Co. <br />14, Are you a Minnesota resident? 546 Yes <br />No <br />If.not, where resident: <br />15. Have you ever been convicted of viola ng Federal, State or Local liquor laws <br />IDand /or regulations? Yes fihd No <br />If yes explain fully on separate sheet of paper. <br />16. Applicant, and his associates in this application, will strictly comply with all <br />rules and regulations promulgated by the Liquor Control Commis - <br />the Laws of the State of Minnesota governing the taxation and the sale of in ox- <br />iionir dual; ; a <br />read the foregoingdquestionsf questions that the answersnto hreby are true ofe <br />my own knowledge. I further understand that an investigation fee not to exceed <br />is0conductedl within the state, or the cost not city <br />not to exceed 510,000.00 a - <br />510,000.00 ifS -veS <br />tigation is required outside the state. <br />3 -4 -54 <br />from <br />dates of residency <br />4 -26 -79 <br />to <br />Subscribed and sworn to befoyp me this <br />daY of 19 /r <br />��� <br />noiafy p b tc <br />My commission expires _ <br />/1. <br />gna <br />ure o <br />p <br />scan <br />FORM-B- APPLICATION QUESTIONNAIRE <br />4 t) <br />