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<br />Indicate below changes of corporate officers. partners. home addresses or telephone numbers: <br /> <br />......- <br /> <br />~ <br /> <br />Indicate below any interest whatsoever. directly or indirectly in other liquor establishments: <br />~ <br /> <br />ReDort below details of liquor law violations (civil or criminal) that have occurred within the last five years. (Dates. offenses. <br />fines or other penalties. includinll Liquor Control Penalties): <br /> <br /> <br />J Tet-~ ~ <br />If 7-[)~ <br /> <br />Report below details involvinl! any license rejections or revocations: <br /> <br />City/Countv Comments: <br /> <br />/6 <br />