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3 pfs.TdT III— PERSONAL I_ I+OR:Nl,.PION City of St. Anthony Liquor & Wine License Application This section should be completed by each individual, partner, officer, manager, proprietor or other agent in charge, and each person who by combined ownership or control has an interest in a corporation or association in excess of five percent (5%) TrucName JEFFREY F. JOHNSON _---- llateofBirth 4/15/1962 _ acaceofBirth�GEORGiA CurrentlIome Address T 1033 I IIDDEN SPIIT 7RAIL LAWRENCEIILLF__S3A 300-45-- R --_ — - --j— --- - --.. c S ate, zip_._._.-------- Oher Names IJsedlAlias - -- -- ' Marital Status —.—_ Sin 1 X .Marded Divorced Spouse's True Name 1CARRIE RENEE SQN --- ----- --- - Date of Bath—�_ Placc of Birth _-- --- ome Address T 1033 FIRMS N SPIRITRAIL, LAWRENCEVILLE, GA 30045 h _ _.-._� _. � -- _-_.. Cttyz Staie, 7r _ -- - Are you or your spouse a registered v oto r? l Applicant -X Yes . No Spouse Yes No 1 Location.Gf:OhGIA 1T.oeaficn — _—__� Residence Address for Preceding 10 Years: __ -- -- rt State Gr . — - Narne, Address and Phone Number o£Indivrduar s Lna losers and Partners for Preceding 10 Years_ Names, Addresses and Phone Number of S Rqns Ell els and. I toels for Preceding -1 0 Years: Has applicant or spouse, or a. parent or sibling or child ever been convicted of ally, crime or violation of any ordinance other than traffic? If so, please furnish information as to the time, place and offense for which convictions were had: NONE. Name, home address and business address of each person who is engaged in Minnesota in the business of selling, manufacturing or distributing liquor and who is nearer to kin to the applicant or spouse than second cousin, whether of the whole or half blood, computed by the rules of civil law, or who is a brother-in-law or sister-in-law of the aPPlicant or the ap�l cant's spouse. __, Military Service (Upon request, you maybe asked to provide discharge papers)} .Yes Y No IM