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<br />. <br />, <br /> <br />I <br />I <br />L__ <br /> <br />MAR-26-0i MDN <br /> <br />'5;; pi <br />-J ,lit <br /> <br />r'1r ^- FO'--~ L'K" <br />'.'. L IJt '.'t,~ j ..II.!l <br /> <br />FAX N~ 651 154 1968 <br /> <br />n ' <br />L I <br /> <br /> <br />Paat-lt" Fax Not. 7671 <br />To <br /> <br />0../00"1. <br /> <br />APPLICATION FORM l<'OR SALJNAtS OK MASSAtO.I!: t'AKLOKS wt;ENSE <br /> <br />INITIAL INVESTIGATIVE FEE S2jO.oo <br />LICENSE PER YEAR $300.00. (NOT PRORATED) <br /> <br />TRAIl! NAME <br /> <br />OATS OF APPLICATION <br /> <br />LICENSING PERJOD <br /> <br />FULL NAME OF APPLICANT. OWNER <br />IF INDIVIDUAL <br /> <br />PHONE NUMBER <br /> <br />STArn <br /> <br />ADDRESS <br /> <br />CITY <br /> <br />DATE OF BIRTH <br /> <br />PUCE OF BlRTH <br /> <br />ADDRESSOFBUSl~S <br />LOCATION <br /> <br />LEGAL DESCRlPl'ION OF BUSINESS LOCATION: <br /> <br />LIST OWNERS Of BULLDINQ OR PREMISE TO BE LICENSED: <br /> <br />NAMES: <br /> <br />ADDRESSES: <br /> <br />DATE OF BIRTHS: <br /> <br />MANAG!1l'S NAME! <br /> <br />ADDRESS <br /> <br />PHONE <br />