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<br />Indicate'below ('hangl".S of coJ.1BOrate officers. partners. home addresses or telephone numbers: <br /> <br />Indicate below a.n.y interest whatsoever. directly or indiJ:ectly in other liquor establi~hments: <br />SA ;r~.p/r: PI fJU6o: f).~.A~ (fA;,,;;;,~ /II2Plh? <br /> <br />Ji8t7 jOJ[5-f f)Wf) JJ .!L) fjv6o/ rh/l/, JJ tJ3t[ <br /> <br />.Report below detJllilll of liquor law violations (civil or criminal) that have occurred within the last five years. (Dates. offe~ <br />fines or other penalties. incJlldinf Liquor Control Penalties): <br />'i'''h~OO - fvf.ihS~)LJ 4a.OJJDl -to (1;.p)()~- fPift~'1fl J/J'fJu:,t) jilt rftlOIJOL SIV/) )Obn jbl1l'9IDj!:/ <br />Hn-OJ- E"'f'1' ,/f1lLlIJ fo't'-'Ml tHftt'J500.OtJ /uJ[ . <br /> <br />Report below details involving any license rejections or revocations: <br /> <br />City/ColJllllty Comments: <br />