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<br />Indicate below ~lumges of col:porate nmce~ parln~ home addresses or ~hone numbers: <br /> <br />..... <br /> <br />n.'" <br />. <br /> <br />;) <br /> <br />Indicate below anY interest whatsoev~ directly or indirectly in other liqp.or estabH!lbments: <br /> <br />Rqmrt below detaillil of IiQJlor law Violations (ctriI or crimfnAn that have N'.M11"I'Pd within the last ~e years. O>a~ o:ff~ <br />fines or other penRlti~ inclniHn~ LiQJlor Control Penalties): <br /> <br />J.. Z 7 - D3 <br /> <br />fA JL~-O <br /> <br />(),IY'J.o4A N~ r e,hec/C <br />I' <br /> <br />. I <br /> <br />" <br /> <br />. . <br /> <br />. . <br />'t _ . <br />Report below deta& involving' any license rejections or revoc8.tio~: <br /> <br />City/County Comments: <br /> <br />.:..... .v.- .:;:.....~ _ _ . o. . <br />