Laserfiche WebLink
05/2a/z012 THv 10:33 FAx 651 63a 5137 City of Arden Hill� <br />Appl�cant informat�on <br />Applicant l�tunc: <br />�. <br />fdj003/005 <br />H.ome Address: %�� � �✓�✓ �� � - <br />� „o.cG'�1 <� ,�� �'�� <br />I�ate of Birth; Place of Birth: _�� ��� � <br />Minnesota Resident: ��Ces From � to ��:c� � <br />❑ No What state do you reside; <br />Un�ited States Citiz�n: �Yes From � � ,�'<<°s-- � <br />❑ No <br />�f tt�turalized, state and place of naturalizatio�t: <br />State: <br />Place: <br />State if applicant or any associate in the application h�s had an application for a liquor license <br />rejected by any municipality or stat� authority. If so, give date and details: <br />� <br />State if appaicant or any associate in the application has ever been convicted of z�ny liquoy law <br />violation or any crime in this state, or any oth�r state, or under federal laws. If so, give state and <br />details: <br />/��J <br />State if applicant or any associate in ths applic�tion is e. member of the gorrerning body of the <br />municipality in �vhich this license is to be issued. If so, in what eapacit�+: <br />�� <br />