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Name and address of former owner: NEW CONSTRUCTION Date purchased: Amount of down payment: Who currently holds the mortgage— name and address: Term of mortgage: ,__ Rate of interest on mortgage: Purchase price: _ -----.—_---__-- Amount of Contract for Deed:. ------ Who currently holds contract for deed — name and address: Terms of Contact for Deed: Rate of interest ou Contract for Deed: State monthly payment at which the mortgage and/or fine the payments on the mortgage and/or contact for deed contract for deed is being liquidated: _____i___ up to date? __Yes -_—No State the amount of the investment that the applicant has in the businoss premises, fixtures, furniture, stock in trade, etc. (Attach supporfhrg proof of the source of such money) Give the frill mules, date-of-birdi, addresses, telephone numbers of all persons, other than the apphcarrt, who have any financial interest in the business, buildings, premises, fixtures, furniture, or stock in rade. State the nature of flee interest amount thereof, and the terms for payment for or other rehnburseluent. (ibis shall include, but not be lunited to, any lessees, lessors, mortgagors, lenders, lien holders, trustees, trustors 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 all persons who have financial interest in the business. Full Name:: First Middle 111st DOB Address:.--�— Phone number: Nature of interest, etc. Full Name:: Fast Middle Last DOB Phone number work �— Home: Nacre of interest, etc. fulliv arne:: Fant Middle Last Doli —,. Address: -'—�.---'-- ----- Phone number Wak _ Nature of interest, etc. If this Application is for premises either planned or under construction or undergoing substantial alteration, the application shall be accompanied by a set of preliminary plans showing the design of the proposed premises to be licensed.