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<br />. <br /> <br />EO'd <br /> <br />5. A. If applicant is a partnership, state full name, <br />resid~nc., and business address, telephone n~mbers. and <br />interest of eaOh ~ember of the ~artnership; (If more <br />than three, include them on a separate sheet.) <br /> <br />Date ot Birth <br /> <br />Interelllt <br /> <br />% <br /> <br />Residence Address________ <br />Residence Telephone <br />Business Address <br /> <br />Business Tele~hone____ <br />Social security Number <br /> <br />Driver's License Number <br /> <br />J. Full Narne_____ <br />tAS'1' <br /> <br />FIRST <br /> <br />FULL MIDDLE NAME <br /> <br />Date of Birth____ <br />Residence Address___ <br />Residence Telephone <br />Business Address______ <br />Business Telephone_o__ <br />social Security Number <br />Driver's License Number <br /> <br />Interest__________% <br /> <br />2 <br /> <br />8~9~~8~199 'ON Xl:i~ <br /> <br />I;/GI:iN\iO 31W 1 :10 All a <br /> <br />zz:~t NOW IO-gZ~dI:iW <br />