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Name and address of former owner: o ____ Date purchased: Amount of down payment: Who currently holds the mortgage—narne and address Tenn of morteage: Rote oPnaeresC on mortgage: State mouttily payment at which the mortgage and/or contract £or deed is being liquidated: Purchase price: Amount of Contract for Deed: Who currently holds contract for deed —name and address: Tenor of Contact for Deed: Rate ofinterest on Contract for. Deed: Ase the payments on the mortgage and/or contract for deed up to date? _Yes No State the amount of the investment that fhe applicant has in the business premises, futures, Bunuture, stock in trade, etc. (Attach supporting proof of the source ofsuch money) Give ibc full names date -of -birth addresscs, Telephonena ebeis of llpersons, other ihtla d,e apphcatu; wh,o have any finatr �'1 interest ii the business, buildings pt r.mses, iwt>�es, fiunitve, or stock>,u s ada Suatc Yhc nature o the interest amount thereof, and the terms for payment for or other rehsibarsement. (This shah include, but not be limited. to, any lessees, lessors, mortgagors, lenders, lien holders, trustees, tustors and persons who have co-signed notes or otherwise loaned, pledged, or extended security for any indebtedness of the applicant.) A release form is necessary for allpersons who have financial interest in the business. /v/q Full Name:: First Middle Last DOB Address: Phone number: work ore Nahne of interest, etc. :Gull Name:: Rust Middle Last DOB Address: Phone number K'or: Home: Nature of interest, etc. Full Name:: First Middle Last DOB Address: ---- — — Phone number work Home: Nature of interest, etc. If this Application is for premises either planned or trader construction or undergoing substantial alteration, the application shall be accompanied by a sett of preliminary plans showing the design of the proposed premises to be licensed.