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City License # <br />CITY OF LITTLE CANADA <br />APPLICATION FOR ADULT USE LICENSE <br />FOR YEAR <br />Accessory Use or Principal Use <br />1. FULL Name of Business: <br />2. Business Address: <br />( Street,Box,Route) (City) (State) (Zip) <br />3. Business Phone Number(s): <br />4. Hours of Operation: <br />5. Applicant's FULL Name: <br />(Last Name) (First Name) (Middle Initial) <br />6. Applicant's Address: <br />(Street,Box,Route) (City) . (State) (Zip) <br />7. Applicant's Phone Number(s): <br />8. Applicant's Date of Birth: <br />9. Applicant's Position With Company: <br />10. If corporation, list below the names, residences, phone number, and <br />birthdates of those owners holding more than 5% of the outstanding <br />stock of the corporation: <br />11. Manager: <br />(Last Name) <br />12. Manager's Address: <br />(First Name) (Middle Initial) <br />(Street,Box, Route) (City) (State) (Zip) <br />13. Manager's Phone Number(s): <br />14. Manager's Date of Birth: <br />8 <br />Page 101 <br />