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PART 11i — PE16ONAL LNFORIlLMON <br />City of St. Anthony Liquor & Wine License Application <br />This section should be completed by each individual., partner, 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 five percent (5%) <br />r._ <br />e <br />PruName __ <br />DateofBirh <br />GUY LEON PETERSEN_ _ <br />_ _ <br />4/26/66 — — Place of Ll L MINNESOTA <br />Current home Address <br />14693 WACO ST RAMSEY, MN 55363 <br />City, Stats, ZiL-----�--.-..._..---.---._---—.._.. <br />---- ---- <br />Other Names U—sed—/Ali-a-s—' <br />----- <br />---1S <br />— <br />tatus_--___— <br />--- —. <br />ule Divorced <br />Aarried—ar <br />S. <br />True Name SANDRA PETERSON <br />_Spouse's <br />Date of Billh _1 dace of Birth <br />Home Address 14693 WACO SI RAMSEY MN 55363 <br />_ <br />City, S atey -i ____.N <br />Are you or your spouse a registered voter? Applicant Yes . No Spouse .Yes No <br />Location IlAMSL Y, M� Location- RAMSEY MN <br />Residence Address for Preceding 10 Years: <br />SAME <br />C1 ,tilt®, hp � <br />Name, Address and Phone Number offn ial's Rinolovet� and Par n rs for Pre dung 10 Yeats: <br />WALTER 1=0RSC1-IEN 763-421-4209 <br />Names, Addresses and Phone Number of Spouse's Employers and. Partners for Preceding 10 leans: <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? If so, please furnish information as to the time, place <br />and offense for which convictions were had: <br />NONE <br />Name. home address and business address of each person who is engaged in Minnesota in the <br />business of selling, manufacturing or distributing liquor and who is nearer to kin to the applicant or <br />spouse than second cousin, whether of the whole or half blood, computed by the rules of civil law, <br />or N ho is a brother-in-law or sister-in-law of the applicant or the applicant's spouse. <br />Military Service (Upon request, you may be asked to provide discharge papers) . Yes x . No <br />