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<br />Required Information for Background Cbecks <br />(Required for the following: sole owner, each partner, each officer, each agent or manager in charge of the premises and for all person who own or <br />control an interest in excess of 5%) <br /> <br />Street Address: <br /> <br />SJlI1AWI( 1.1 J1Ji;tl,JU-o{A,;t.Jt, <br />SAbGI/S &tt~;V-h/)IUL <br />1P'/<6 U.,dfl)rJIU.! 10,11) <br />tL ~ t ~viU (, )YI fil, S 5 i)J3 <br />, <br /> <br />Name: <br /> <br />Business: <br /> <br />City, State, Zip: <br /> <br />Applying for: <br /> <br />[)4 Liquor <br /> <br />I)Q Tobacco <br /> <br />