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8 PART B1— PERSONAL INF0101A'. ION City of St. Anthony Liquor & eine 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 owuerslup or control has an nCerest in a corporation or association in excess of five percent (5%) Trueldame IWALTER WILLIAM FORSCHEN ---- Date ofBirth 6/21/49 _ 1?lace ofBir� MI1ACA,MN_-----....---___.._ -- C`.urrentl-lome Address 3962_ ENCHANTED DR, ANDOVER, MN 5G304 Names M -- -- arital Status Shrple X _Martie `Divorced Souse's TruName PATRICIA RAE GRUNW_ALDT --- _ _ 5ateofBirlh i/12/49 �ER,PlaceofBirth ROCHESTER MN _ —_ - —" -- ,n,96M CNCHANTCD DR, AND -OV MN 55304 Home Address --- Aye you oryourspouseiregisteiedvotcz? Applcart-XYes .No Spouse XYes No 17 nrar.on ANn0A/FR Location: ANDOVER Residenec Address for Preceding 10 Years: SAME AS ABOVE - -- ------ Iamr,, Address and Phone Num'ucr of Indiv rdu l s l nPlo y r s <na Par bier s lo-,,-.,dinR 10 Years: ---- --- — SANDRA PETERSON (SEE ABOVE) ----------- _.._MIKE LEBLANC -._- __.. __._.-_._----_---------------- Names, Addresses smd Phoue I umber of S�ousc's Tiloye s slid Partner for Preceding 10 Years: TIas applicant or spouse, or a. parent or sibling or child ever, been convicted of any, cr me 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 Nape, 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 roles of civil law, or who is a brother-in-law or sister-in-law of the ap recant or the apolicanfouse. ,___.__ Military Service (Upon request, you may be asked to provide (Ischa_ge papers) _ -, _ _YeS_ XiNO W"