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m <br />Name and address of former owner: <br />Date purchased: <br />Amount of down payment: _.____ <br />Who currently holds the mortgage -name and address: <br />Term of mortgage: <br />Rate of interest on mortgage: <br />State leonffi1y payment at vvbi ch the mortgage and/or <br />contract for deed is being liquidated: <br />—.._--.__—..--- <br />Amount of Contract for: Decd: _ <br />Who murently holds contract for deed- nine and address: <br />'Perms of Contract for Deed: <br />Rate of interest on Contract for Deed: <br />A o he payments on the mortgage and/or contract for deed <br />uu to date? .__�'as _.__No <br />State the anrotmt of the investment flzat the applicant has in the business premises, Fixtures, fuuiture, stock in trade, etc. <br />(Attach supportingproof of the source of such money) <br />Give fr fuli names, date of bn.ua, aadresses, telephone nt ,nbers of Itil pet son , ober than the inphcaat, who have any <br />financial. interest in the business, buildings, premises, %;tures, fisniture, or stock in Made. Sta e tiro na ure m: ue n eresC <br />amount thereof, and, the. terms for payment for or other reim'oursemenY, ('This shall include, bu n.ot be limited to, any <br />lessees, lessors, mortgagors, lenders, lien holders, ftustees, trustors and persons who have co-signed notes or otherwise <br />loaned, pledged, or extended. security for any indebtedness of the applicant.) A release form is necessary for all persons <br />who have financial interest in the business. <br />FullNamc:: ilist Middle Last DOB <br />G ipot le Mexican Gr:Ll:1., Inc__—.,______—___ <br />Address: <br />1.543 <br />Wazee St., I)enver, CO £10202 <br />Phone number: <br />Worn: <br />-_—_..--. Home: <br />2Qatureofinterest, etc. <br />Sole <br />-- <br />owner of applicant <br />- <br />Name:: <br />FurllLiame:: <br />Rust <br />St_ <br />Middle Last DOB <br />Anthon Retal Develo ments, LLC <br />Address: <br />7650 <br />Edinborough Wa- Suite 37.5, hdina,_MN 5543_.___ <br />s - -- <br />Phone number <br />Work: <br />Home: <br />— <br />Natueofinterest,etc. <br />Lessor of premises <br />Full Name:: <br />First <br />Middle Last DOB <br />Address: <br />Phone number <br />work <br />Nature of interest, etc. <br />If this Application is for premises either planned or under construction or undergoing substantial alteration, the <br />application shall be accompanied by a set of preliminary plans showing the design of the proposed premises to be <br />licensed <br />