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M <br />CORPORATION OR ASSOCIATION <br />(To be filled out by at Officer of the Corporation or Association) <br />List the name or corporation or association, St. Anthony address and phone number and home office address <br />NTdll7e ST, ANTHONY RESTAURANT GROUP, INC. <br />State of Inc. or Assoc. <br />Fridley address <br />Phone number <br />Home office address <br />Phone number <br />14693 WACO S -T RAMSEY,MN 55363 <br />List the frill names, home addresses, <br />President GUY LE <br />Full name Fig <br />numbers and date -of -birth of all officers of saidcorporation or association. <br />Home Address: 1_4693 WACO ST RAMSEY'MN 55363 _ ,— <br />Phone Number Hom763-421-4209 worx763-433-0989 <br />Date of Birth <br />---- --------------------- <br />Vice-Presidenf <br />Full name <br />Fiat WALTER <br />Home Address: <br />3962 ENCHP <br />PhooeNumbcr <br />Horne work <br />Datem"Birth <br />6/21/49 <br />Secretary <br />Full name, Fiat <br />.[-Tome Address: <br />Phone Number _ Tor <br />Date of Birth <br />Treasurer <br />Middle WILLIAM Iut <br />gDOVER. MN 55304 <br />—"--" Work 651-248-01" <br />Middie Last <br />Full name <br />Fi nGUY LEON PETERSENUdlo Last <br />Home Address: <br />PhoneNumber <br />Horne work <br />Date of Birth— <br />List the firll names, home addresses andphone numbers of all persons who singly or together with their spouse, parents, <br />brothers, sisters or children, <br />own or control .m interest in said corporation or association in excess of 5% and date. of <br />both. <br />Full name <br />Flat GUY Middlc LEON —_Last PETERSEN —_ <br />I -Ionic Address: <br />__�_—.---- <br />Phone Number <br />_ — <br />Work <br />- <br />Interest <br />_ <br />Date of Birth <br />T'i lname <br />rust WALTER Middle WILLIAM ". FORSCHEN _ <br />Home Address: <br />--- <br />^worx <br />Phone Numbez <br />riome <br />—._._.------------ <br />Date of Birth <br />Full name <br />First JEFFREY Middle FRED Last JOHNSON <br />home Address: <br />1033 HIDDEN SPIRIT TRAIL LAWRE.N •BVI( E—GAI004F <br />Phone Number <br />klo'nc 404-867-8964 work <br />Interest <br />Date of Birth <br />4/15/62 <br />