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-3- <br /> •Personal Information ` <br /> 16. Have you, your spouse, or a parent, brother, sister or child of either of you, <br /> ever been convicted of any felony, crime or violation of any. ordinance, other <br /> than traffic? Yes . No _�. If Yes, give information as to the time, <br /> place, and offense Tor-which convictions were had. <br /> 17. Have you, your spouse, or a parent, brother, sister or child of either of you, <br /> ever been -engaged as an employee or in operating a saloon, hotel, restaurant, <br /> cafe, tavern or other business of a similar nature? Yes No . X,_ <br /> If Yes, give information as to the time, place, and lengtF f time. <br /> 18. Have you been in military service? Yes No <br /> If Yes, was discharge(s) ever other than honorable? Yes No <br /> (Upon request, you may be required to exhibit all discharges.) <br /> being first duly sworn upon his/her oath, deposes <br /> and says that he/she is the person who has executed tht above Personal Information Form, <br /> and that the statements made therein ate true of his%h.er of ^owledge and belief. <br /> Signed: <br /> Subscribed and sworn to Lcfo'fe- cjc this, day of C_.�a . 19 �3 <br /> Notary fub1ic �'�,`-c izhty , <br /> My Commission Expires �<<''9, �. , .^�rC auNY P M <br /> ray COmR1�5:�� <br />