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<br />Indicate below changes of coI:POrate officers. partners. borne addresses or telephone numbers: <br /> <br />Indicate below any interest whatsoever. directly or indirectly in other liquor establishments: <br />5I1H'..q.PK PI flu/;? ~ j)/J.A. 5Ab,UAl c~ //LfJ/tJ!t <br /> <br />/181r JOJIS-I f)tJJf) i:I !L I !1v6o/ /11/1/, JJ o3c{ <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. includinf Liquor Control Penalties): <br />tj..JhvOO - fv.ePJ5~W. tjaOJ/lJl -(0 rl;vo~- ffil/'~,,)fl SAn'o /Hi IhlllUOL ~flI() SOb/) fot1J.vORS} <br />1- :J2-03- i"f'fl ~itflJ I'o'fl/Mll (Hftk'-'5tJo.{)() ;;4. <br /> <br />Report below details involving any license rejections or revocations: <br /> <br />City/County Comments: <br />