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PL PACKET 03151983
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PL PACKET 03151983
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Last modified
12/30/2015 3:49:50 PM
Creation date
12/30/2015 3:49:22 PM
Metadata
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SP Box #
16
SP Folder Name
CC PACKETS 1981-1984 & 1987
SP Name
PL PACKET 03151983
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-3- <br /> �rsonal 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 INo . ..If Yes, give information as to the time, <br /> place, and offense or which c nvictions 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 <br /> If Yes, give information as.~to the time, place, and lengtF of time. <br /> 18. Have you been in military service? Yes No <br /> If Yes ,I was discharge. /honorabl l Yes No <br /> (Upon request, you may be required to exhibit all discharges.) <br /> being first duly sworn upon his/her oath, deposes <br /> arJ says that he:/she is the person vho--has execuLe:d the abore Personal Information Form, <br /> and that the state:aents made therein ,are true of his/her own rot.lcd!gc and belief. <br /> Signed: <br /> Subscribed ar.J sworn to before me this 6_- day of <br /> !rotary f ubl is 'J ;� Cou,tit� <br /> My Commission Expires j <br /> 0 <br /> CAROLINE L. ZAPPA <br /> MENN991111 COUNTY <br /> NOTARYPUO►1S.MINNE:SL:'F t <br /> �. �•u�stcti E■Ilgfa MAR. 9. 19i 75 <br /> • <br />
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