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Applicant Information <br />Applicant Name: %� � �c' /' �� �= N «�- � <br />Home Address: � � � � /��-�,r 4 �� �-�� <br />1.+..`'l"/ /( 4:�� GG/ C' /^� l� L- l�. SL L:' � �L��L`� , r'.� "5•._� �� <br />Date of Birth: � - � 3 -�s �' <br />Minnesota Resident: � Yes <br />❑ No <br />United States Citizen: � Yes <br />❑ No <br />Place of Birth: �1 c"%� ;� �� <br />From ��,�- to �7,=,�_n.,�n�,P..- <br />What state do you reside: <br />From r��' °� to f -;��--���-�,�T--.. <br />If naturalized, state and place of naturalization: <br />State: <br />Place: <br />State if applicant or any associate in the application has had an application for a liquor license <br />rejected by any municipality or state authority. If so, give date and details: <br />��� <br />State if applicant or any associate in the application has ever been convicted of any liquor law <br />violation or any crime in this state, or any other state, or under federal laws. If so, give state and <br />details: <br />State if applicant or any associate in the application is a member of the governing body of the <br />municipality in which this license is to be issued. If so, in what capacity: <br />� <br />