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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 /> Crystal Bay, MN 55323 <br /> Phone: (952) 249-4600 <br /> Directions: This form must be filled out with typewriter or by printing in ink. !f the application is by an <br /> individua!person, by such person; if by a corporafion, by an officer fhereof; if by a partnershrp, <br /> by one of the partners; if by an unincorporated association, by the manager or managin�r <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°/o On Sale ($100.00) <br /> � Off Sale Intoxicating ($150.00) ❑ 3.2% Off Sale ($50.00) <br /> License year: 200�rI (January 1 — December 31) <br /> 1. Name of applicant/licensee (name of individual, partnership, association or corporation): <br /> � , . � <br /> /���i�'.�K;�s ��G�c:c�1s .� ��. . <br /> Business Trade Name �Yi�G'�f.�':�'F_ �i'C�c%c,�� -�-i,�e' . <br /> / ,�.�3 i�- <br /> Business Address ��/� / ����%,�'�=G�i�/�= j���. �,/3�'%�,��',= Phone �.5�-�%�/-�'�o� <br /> (SVeet) (City) (ZiP1 <br /> Mailing Address (if different) �/��.>''" ��''L-�i�i%�':� �L�'i� /��70//i�ii� ���G v <br /> (Street) (City) (Zip) <br /> Licensee's Minnesota Tax Identification Number ����'7/3.SJ <br /> Licensee's Federal Tax Identification Number C1�� /`'�'' 5��� <br /> 2. If the above named licensee is an individual, complete the following: <br /> a. <br /> Individual Name (First) (Middle) (Last) Date of Birth <br /> Home Address (Street) (City) (Zip) Home Phone <br /> If the above named licensee is a partnership, association, or corporation, complete the following for <br /> each partner/officer. <br /> J //%(/J%?� �7�0/�/c S �'�fl� �J' r <br /> a. � ,� F���.�,� ��� <br /> Partner/Officer Name (First) (Middle) (Last) (Title) Date of Birth <br /> Home Address (Street) (City) (Zip) Home Phone <br /> b. <br /> Partner/Officer Name (First) (Middle) (Last) (Title) Date of Birth <br /> Home Address (Street) (City) (Zip) Home Phone <br /> C. <br /> Partner/Officer Name (First) (Middle) (Last) (Title) Date of Birth <br /> Home Address (Street) (City) (Zip) Home Phone <br />