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<br />Indicatebelowchangf!l'l of cOl:porate officers. partners. home addresses or telephone numbers: <br /> <br />Indicate below any interest whatsoever. directly or indirectlv in other liquor establishments: <br /> <br />Report below details of liquor law violations (civil or criminal) that have occurred within the last five years. (Dates. offenses. <br />fines or other penalties. incIudillll Liquor Control Penalties): <br /> <br />,.kJ,J(/ II If 1 :)7 p-t .2 001 Vi }LF" n I'll PI I Itlt oJC.C <br />r h eC IC $ 5t:J 0 '!-(.) Ii ~€ <br />Etn~ /()'1@. e CI1nPCe-5 D,smJ.~S€ p J^, e,7 ulJr <br /> <br />Report below details involving any license rejections or revocations: <br /> <br />City/County Comments: <br /> <br />-.J <br />