My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2007-11-28 CC Packet
Centerville
>
City Council
>
Agenda Packets
>
1996-2022
>
2007
>
2007-11-28 CC Packet
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/21/2007 2:30:06 PM
Creation date
11/21/2007 2:29:11 PM
Metadata
Fields
Template:
General
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
165
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
<br />------,. <br />-.---.. <br /> <br />CITY "OF CENTERVlLtE . <br />INTOXICATION MALT LIQUOR LICENSE <br />APPLICATION <br />DRAM SHOP INSURANCE EXEMPTION <br /> <br />I hereby certify under penalty of perjury that I have applied for an intoxicating liquor/on- <br />sale wine license ana..that tt", "afc:s vf :su",h B8""a8~il aR lililil tbm t 1 O,QB9 per )c:ftf. In <br />addition. I certifY that the attached list of mv wholesale suppliers is true and correct. If <br />necessary, these suppliers may be contacted in order to confirm this declaration. <br /> <br /> <br />//J." ;22- <br /> <br />" <br /> <br />{)7 <br /> <br />Date <br /> <br /> <br />/tI / z. V;/07 <br />Date <br /> <br /> <br />. <br /> <br />JMEI PATRICK 8fWIa41 <br />NO'TNIYPIIar ._m <br />1Ite.-......_ ...... <br />F <br /> <br />NOTE: A LIST OF YOUR WHOLESALE SUPPLIERS MUST ACCOMPANY THIS <br />DRAM SHOP EXEMPTION FORM. <br /> <br />~Jr~ <br />(i1~ ~ ~ <br />)/~ <br />;11M JLLC <br />-~~ <br /> <br />--~-:T~ ~. <br />124. <br />--IJ~ <br />
The URL can be used to link to this page
Your browser does not support the video tag.