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PART 111-- PERSONAL 1NFORMAT1O.N 829 <br />City of St. Anthony Liquor & Wine License Application <br />This section should be completed by each individual, partner, officer, manager, proprietor or other <br />agent in charge, and each person who by combined ownership or control has an interest in a <br />corporation or association in excess of five percent (5%) <br />Tru.eNamo <br />Date of Birth C_l (�_ Place of Birth je-Ifz <br />Current lImnle Address 52 g ! % �C4&,c <br />----- <br />CS�, <br />Other Names Used/plias' <br />Statuss Snngle� .Marr ed Divorced. <br />S orut elf ru c ivam -� �- s <br />�__ I <br />�Date of Bnth —Place of Bitth � <br />1lomc Add mss 016-1 - <br />- _ _ _ <br />Arc you or your spouse a. registered voter? , Applicant - 'es . No Spouse - . cs <br />1 ocatron: <br />__...._ L _.. - <br />Residcnce Address for Preceding 10 Fears: <br />(See. 4=64) <br />� Crty SiaPc /rp � <br />_ <br />N ane, Add~ ss and Pb 10 Years <br />c- <br />— cf- t� ! - - — — — - - <br />Names, Addresses and Phone Number of Spouse's Employers and Partners for Preceding 10 Years: <br />------ --- -- -- ---- - --------------- <br />Has applicant or spouse, or a parent or sibling or child ever been convicted of any, crime or <br />violation of any ordinance other than traffic? If so, please furnish information as to the time, place <br />and offense for which convictions were had: <br />NO <br />Name, home address and business address of each person who is engaged in Minnesota. in the <br />business of selling, manufacturing or distributing liquor and who is nearer to loin to the applicant or <br />spouse than second cousin, whether of the whole or half blood, computed by the rules of civil law, <br />or who is�a brother-in-law or sister-in-law of theap�hcant or the applicant's spouse. <br />Military Service (Upon request, you maybe asked to provide discharge papers) <br />