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11, If this is a transfer application givr. nano, adJress, of persons, partnership or <br />corporation holding license for the pant yrar, <br />12, Who owns the tavern fixtures?/li•`/rs%'(/av /�l`1�',•� /��/�.�/ <br />13. What vending or 'lie chanicaI amusement device cnugavey has or will have machines on <br />the licensed premise? <br />14. Are you a Minnesota resident? Yes U ilo,�j i1Zo� <br />tirom to <br />If not, where resident: dates of residency <br />15. Have you ever been convicted of violating Federal, State or Local liquor laws <br />and/or regulations? <br />Yes _ ir'o <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 />the Laws of the State of Minnesota governing the taxation and the sale of intox- <br />icating liquor; rules and regulations promulgated by the Liquor Control Commis- <br />sioner; and all ordinances of the municipality; and 1 hereby certify that I have <br />read the foregoing questions and that the answers co said questions are true of <br />my own knowledge. I further understand that an investigation fee not to exceed <br />$500,00 shall be charged an applicant by the city or county if the investigation <br />is conducted within the state, or the cost not to exceed 510,000,00 if the inves- <br />tigation is required outside the state. <br />ego <br />pp icap_, .t2'P1�,2� <br />Signature of A 1' nt <br />Subscribed and sworn to before me this <br />��• day of la As ,, <br />g '", maaa+eaa o �,rrt-r <br />ltrtq <br />I .( ;are rrurl r, <br />h'^a,lra <br />(� <br />notary p Tc ...,-lrccn'mrQ1JC.ou:)Tp:�;lon4rarav�,t <br />My commission expires <br />