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1 <br />APPENDIX A <br />ATTACHMENT TO LICENSE APPLICATION <br />FOR AMUSEMENT DEVICES AND CENTERS <br />Address of Business 12430 County Hwy 10 <br />Business Name Dean Superior Vending Co. <br />Type of Business conducted IMovie Theater <br />at this location <br />Description of the machines to be covered by this license, mechanical features, name of <br />manufacturer and serial number (attach list if necessarv) <br />17 Amusement Devices such as cranes, video games, driving games, air hockey and a basketball game <br />Ne�a�fieants: References {Cities where <br />Year <br />or currenly licensed for same <br />Name of Citv <br />I hereby certify that the above information is true and correct and I understand that any <br />misrepresentation made here ma be grounds for denial of this application. <br />Applicant (as <br />shown on applications) <br />Signature �- <br />Date j7/2'9/2021 <br />