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dicate below changes of eor Qrate officers. partners. home addresses or t&phone numbers: <br /> nfa <br /> ndicnte below NY interesLvvhats Urmtly or Indirectly'm other Iiauor olablbhme • <br /> see attac store list <br /> Rt�rt below details of liauor law violations (civil or criminal) that have occurred within the last five years. (Dates. offenses, <br /> fines or other penalties. inch din Liauor Control Penalies), <br /> Licensee does not have any violations at this store in the last five years. <br /> /47 <br /> Rewrt below details invol►vinp. auv license teiections or revocations: <br /> nla <br /> City/County Comments: <br />