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<br />Indicate below chan2es of corporate officers. partners. home addresses or telephone numbers: <br /> <br />Indicate below any interest whatsoever. directly or indirectly in other liquor establishments: <br /> <br />Report below details of liquor law violations (civil or criminal) that have occurred within the last five years. (Dates. offenses. <br />fines or other penalties. includin2 Liquor Control Penalties): <br /> <br />Report below details involvin2 any license rejections or revocations: <br /> <br />City/County Comments: <br /> <br />JiI <br />