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<br />Indicate below chan~es of corporate officers. partners. home addresses or teleQhone numbers: <br /> <br />IV ~ '7 e..- <br />, <br /> <br />Indicate below any interest whatsoever. directly or indirectly in other liquor establishments: <br /> <br />~tJn -e <br />I <br /> <br />Report below details of liQuor law violations (civil or criminal) that bave occurred within the last five years. (Dates. offenses. <br />tines or other penalties. including Li"QU:- Control Penalties): <br /> <br />;:;""L~Q CO/7'7~L.//lA/ee c.J;eeK /--d7- 2003P(ZZ~ <br /> <br />.. <br /> <br />Report below details involving any license rejections or revocations: <br /> <br />/1/ (J /7 -e <br /> <br />City/County Comments: <br /> <br />---~----- & <br />