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Indicate below changes of corporate officers, partners, home addresses or telephone numbers: <br />Indicate below any interest whatsoever, directly or indirectly in other liquor establishments: <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, including Liquor Control Penalties): <br />Report below details involving any license rejections or revocations: <br />City/Coin Comments: <br />