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15. Names and addresses of.your employers and partners, if any, for the preceding ten years. <br /> (Begin with the present or last one first and work back) <br /> Names: Employers or Partners Addresses: City & State Dates <br /> Yid AMBAssADe.R S6.S1 , 1wy 12 MPLS .tAN 1185 <br /> Personal Information: <br /> 16. Have you, your spouse, or a parent, brother, sister or child of either of you ever been <br /> convicted of ayy felony, crime.or violation of any ordinance, other than traffic? <br /> Yes_ No Z If yes, give information as to the time, place, and offense for which <br /> convictions were had. <br /> • 17. Have you, your spouse, or a parent, brother, sister or child of either of you ever been <br /> engaged as an employee or in operating a saloon, hotel, restaurant, cafe, tavern or other <br /> business of a similar nature? Yes_No_\[. If yes, give information as to the time, place <br /> and length of time. <br /> 18. Have you been in military service? Yes_ Noy <br /> If Yes, was discharge (s) ever other than honorable? Yes._ No_ <br /> (Upon request, you may be required to exhibit all discharges.) <br /> ����,� ,,.cC��C , being first duly sworn upon his/her oath,deposes and <br /> says that he/she is the person who has executed-the above Personal Information Form, and that <br /> the statements made therein are true of his/her own knowledge and belief. <br /> Signed: L,,4- <br /> Subscribed and sworn to before me thisjday of . Li u P_ 19 . <br /> Notary Public Q - County <br /> My Commission Expires T9-yG; •,r,,:.._.••x <br /> CONNIE J.KROEPUN <br /> X0 q07AFgy pjqW.Y?t IWA <br /> HENNEPIN COUNTY <br /> W Cam Exp.Apel 25.1996 <br /> )Cr'f <br />