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Attachment A <br />1.285 F-0, R I V ATE <br />Nazareth Council Inc. <br />Knl'ghts of Columbus 4021 <br />2233 N Hamline Ave/Sul'te B-12 <br />Rosevi I Ile, MN 55113-5010, <br />I' 14y sigm'ng this renewal application, applicant certes that there has, been, no change in, owners1fip, corporate officers, bylaws <br />ruembership, partners, home addresses, or telephone numbers. If"changes have occurred during the past 12i months, please givi <br />fetails on the back of this renewal, then slign below. <br />City Clerk/Cotmty Auditor Date <br />(Signature certifies that a consumption and display, permit has been, approved by the city/county as stated above.) <br />P <br />