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10/04 APPLICATION FOR RENEWAL OF ANNUAL INTOXICATING LIQUOR, <br /> WINE, 3.2 PERCENT MALT LIQUOR, AND SETUP LICENSES <br /> City of Orono <br /> 2750 Kelley Parkway <br /> P.O. Box 66 <br /> ��� t� Crystal Bay, MN 55323 <br /> Phone: (952) 249-4600 <br /> Directions: This form must be filled ouf wrth typewrifer or by printing in rnk. lf the application is by an <br /> individua!person, by such person; if by a corporafion, by an officer fhereof; if by a parfnership, <br /> by one of fhe partners; if by an associafion or corporafion, by the manager or managrng <br /> officer. <br /> License type: (check all that apply) <br /> ❑ On Sale Intoxicating Liquor ($5,000,00) � Club ($200.00) <br /> ❑ Wine ($2000.00) ❑ Setup ($100.00) <br /> �''Sunday Liquor ($200.00) ❑ 3.2% On Sale ($100.00) <br /> ❑ Off Sale Intoxicating ($150.00) ❑ 3.2°/o Off Sale ($50.00) <br /> License year: 2�3"�ap� (January 1 — December 31) <br /> 1. Name of applicant/licensee (name of individual, partnerahip, association or corporation); <br /> c��.y��.�� C��p f�.�, ��.4� <br /> Business Trade Name S�YrE <br /> Business Address �ab ��.v��l�- ���� G''• W�y��('�. �'� s�=�� Phone �Sd-��.�"�%��`�� <br /> (slreet)' <br /> �c�,y> ' cz:a) <br /> Mailing Address (if different) <br /> (Slreet) (City) (2ip) <br /> LIC�nSnA�S �/!lnn2SOIu T�uX lriAntiji�a�jn�-; Rli�n�fj?i o�.3i-��� <br /> Licensee's Federai Tax Identification Number �✓-a%1�" ��� <br /> 2. If the above named licensee is an individual, complete the following: <br /> a. <br /> Individual�lame (First} (Middle) (Last) Date ot Birth <br /> Home Address (Street) (City) (Zip) Home Phone <br /> if the above named licensee is a parinership, associatior�, or corporati�n, complete ihe ioliowing for <br /> each partner/officer: <br /> a. r�,c��c=� ����� �� <br /> P2rtner/Officer Name (First) (Middle) (Last) .e �: c:-r, <br /> �fP�'�' �oa�',�¢pr �' ��� ��,���dy�� l�� �s.��-`� '� _ <br /> Home Address (Street) (City) (Z�p) Home <br /> ' GtJ�s%�t�- <br /> b. ��on s t' —--- - <br /> Pzrtner/U'��icer i�iarr�e (�irs[j (iv1;ddle) (Las�} ° <br /> ��.s� � f� % �� /J �f�����;� e�� �sari �� <br /> J Gafv �°" e �t � v <br /> Home,4ddress (Si•r�'etj (Cit� (%ip) Home Pho��e <br /> C. C�u� �:J"�r � �t=/V�'Wr�i- <br /> � � - �' �ifsll �diidt�lcl , ;L'c5`) �2!E Oi°ir'h <br /> c�i'l�f% i1i..�i�vo�a (i <br /> �i�l( ��� 'h-u c ;� !-lv f��o' ^ ��''I%J r: �3`�� _ <br /> _ �.... . ,-, ., �,--- �--- <br />