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727 <br />(Corporation Page 2) <br />Fust: Middle Last <br />Home Address: <br />Phone Number <br />Interest <br />Dace of Birch <br />Dull mune <br />Home Address: <br />Phone Number <br />Interest <br />Date of Birai <br />Manager, proprietor or other agent in charge of the corporofion or association to be licensed <br />Dill ll2IIle Dirt Gregory NRClle Ernst Last HLLL <br />Home Address: 1141 3rd St NW.;eCq Bri �— <br />PhonoNumbcr ILOte 651-283-1989 Work y87-949 L_ <br />DafeofBvrth <br />_(Manager not yet known. Mr. Hil:L is the interim manager <br />and will act as the area manager once a manager is assig-n.ed <br />to this location.) <br />