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PART IR - PERSON -M, J`NNF ORATATI O <br />13® <br />City of St. Anthony Liquor & Mine License Application <br />This section should be completed by each individual, par0ner, 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 Eve percent (5%) <br />n <br />True Name i <br />- - -- <br />IrDate ofBirth r..Aa3 ��? - - I Place ofBirth <br />C I rent Home Address <br />City, State, Zip i i <br />Other Names Used/Alias' <br />Marital�Shat S_ Silrgle Married Divorced <br />-- -- — — - - <br />DateofBrh Placeo:f,Birth <br />Home Address _ rysoq e I rnooh. eirde- <br />---{ <br />Cry!etae Zio {g'S <br />&ca <br />- - - <br />hre you or you, spoase aregi'czed voter? Apphc ani �0 . No Spouse 'CIV No <br />si <br />ce --- <br />I oca[ron: rh_75' (r <br />12Loca�ron � Residence Addy oss .for Pr ecccnng� L0 Ye<.1rs: f i <br />�/ <br />City, Stag Zip - _ <br />_ <br />l's Employers and. <br />diTI6) 10 <br />Mane, <br />fin?c{sl�--iel/rs.lr/i�ui}xcl!r- <br />_Years: <br />{52peS��W_ C <br />Ye%'tra ��nL 1_ a d° <br />`s <br />I--- 'its__f'}1�r�r���-t��y�x2��—..___.._r3R-�� <br />r Names, Addresses and Phone Number offSouse;s Employet_s and Partners for Preceding 10 Years, <br />---- <br />(—_' Qn.9raS---- - --- <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? I.f so, please furnish information as to the time, place <br />and offense for which convictions were had.: No <br />;Name, home address and business address of each person who is engaced.Jra Tvh lncsota in the <br />business of sclhg, manufacturing or distributing liquor and who is nearer to kin to the applicant or <br />spouse than second cousin, vvhether 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 the applicant or the apl icant's spouse. <br />--- — <br />�------------ <br />Military �eI rice (Upon requesP, you ray be askedto provide dischargepapers) <br />p ^ a <br />---- =- -- - - ) No <br />