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8 <br />T'AR'T III — PERSONAL INI ORIMA'TION <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 (S%) <br />True Name <br />rALTER WILLIAM FORSCHEN _ <br />Date of Birth <br />6/21/49 — ^�PlaceofBrth MILACA,MN <br />Current Home Address <br />3962 ENCHANTED DR 91yL?QVEB 1 N 553D_4. - - <br />City, State, Zip_..--.._— <br />— <br />Other Names Used/Alias' <br />Marital Status _ _ _,S agle Married . Divorced <br />Souse's True Name PATRICIA RAE GRUNWALDf_.._- ---- —.__—___._._ <br />_ <br />�_ <br />_Date of Birth 7/.12/49aceofBirth._ 130C�ESTERrN1Ad---... <br />__ <br />Home Address 3962 F,fLCL3L NIEL�P _ANL�O.VR MA3 34----------- <br />t: State,--�...... _.— <br />Are you or your spouse, a registered voter`? Applicant -XYes . _'NT0 Spouse - XYes No <br />[Location!' <br />NI CR, MN Location: ANDOVER, MN <br />Residence Address for Preceding 10 Years: <br />SAME= AS ABOVE. <br />Crty,Mate, GrL j___ _ _ <br />C Name, Address and Phone Number orindividr.-1 s nim loyers and Pa vers for Precedin 10 Years:_ <br />GUY E. PETE_RS()N -SFE ABOV _1 — - <br />SANDRA PETERSON (SEE ABOVE) <br />MIKELEBLANC ---_-� <br />_--__-- <br />Names, Addresses and Phone Number of Spouse's Em to e's and T'a Hers for Preced n l0 Yeaxs: <br />-----�_. <br />NONE ------- ---.....— <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 who is a brother-in-law or sister-in-law of the applicant or the ap 1p icant's spouse. <br />NONE ---- - ---- — ------ <br />Military Service (Upon request, you may be asked to provide discharge papers) _ _T _ - . Yes X No <br />M <br />