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Page 2 <br />Application for On Sale and Sunday Into�cating Liquor License, Part 1 General Information <br />B. The full name, residence address, and telephone number of the manager, proprietor, or <br />other agent in charge of the individual owner's premises to be licensed: <br />1. Full Name <br />Last IYrst I�11 Middle Name <br />Date of Birth Interest % <br />Residence Address <br />Residence Telephone il <br />Business Address <br />Business Telephone �1 <br />Part II, Personal Information Form, must be flled out and attached for this individual <br />6. A If applicant is a partnership, state full name, residence, and business address, telephone <br />numbers, and interest of each member of the partnership: <br />1. Full Name n/a <br />Last FYrst F�11 Middle Name <br />Date of Birth Interest % <br />Residence Address <br />Residence Telephone (� <br />Business Address <br />Business Telephone l: <br />2. Full Name <br />Last FYrst F�ll Middle Name <br />Date of Birth Interest % <br />Residence Address <br />Residence Telephone �) <br />Business Address <br />Business Telephone ): <br />