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` <br /> 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 musf be filled out with typewriter or by printing in inl�. /f fhe application is by an <br /> rndividual person, by such person; if by a corporation, by an officer thereof; if by a partnership, <br /> by one of the par�ners; if by an associafion or corporafion, by the manager or managing <br /> officer. <br /> License type: (check all that apply) <br /> ❑ On Sale Intoxicating Liquor ($5,000.00) ❑ Cfub ($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) Q 3.2% Off Sale (�50.00) <br /> License year: 2005 (January 1 — uecember 31) <br /> 1. Name of applicant/licensee (name of individual, partnership, association or corporation): <br /> ��f, i;f.��•� �-. L, �1 ;ii`Z�' ic � �, �-+�' ��-;;5 ; V-1?! C� - <br /> Business Trade Name �i -��c �� r v fa ti� � �"1 � �- � ���-� F' <br /> �.� __, ,� .- � .- _� �, _.. <br /> Business Address � L(-�� ��1��`����;���'{'�'�7 E'�� ��4'�-?f?�^ ; -���i� Phone y' y Z � 7 I-G�i s"�s� <br /> (S lreet) (City) (Zi P) <br /> Mailin� Acidress lif different) i`�. (} . %� �� �' % '-� �'��.r?��%�'r�e� �;--�`-�`;2 <br /> (Streeq ~� (Cily} _ (ZiP) <br /> I oo'c � a ta a � I a ff'r Nii P //`� / �- `'-Ct`(�r <br /> icers.... M:nn.,so.., T��. d..n.�.i..ation mb..r <br /> Licensee's Federal Tax Identification Number `'! f ��'�l t' ��� ''- L' <br /> 2. if the above named licensee is an individual, complete the iollowing: <br /> a. <br /> Individual Name (First) (�iddle) (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 /> a, �E ;��.' �nl�(,' ;i�-i�. �- ��, r : �; L� � v,�l �'-�f <br /> Partner/Officer Name ,�(First) (Niiddle) (Last) a e o �r <br /> �:�, ; • �, ''' rr� `/ <br /> ;� -I �l ��' f l �" !' i•-�• � �'t (`;'� i� �'t�)�i�� ���i�. il r:%i f�.S� :>� <br /> Home Address (Sireet) (City) (Z�p) <br /> �'�!; �f,,� j� ; �'1 L i� �-,.1.i i"� <br /> b. r. <br /> PartneNOfficer Name (Firsi} (M�ddle) (Las.j ��t c� i �n <br /> - , .-� ,,i,l l,; ] .. -: :-, {, r..J � �C' ; �, <br /> Hon�eAddress (S�reetj (G�y) (Z�c)� ,om' one �� <br /> G <br /> Partner/Of-ficer N�me (�irsr� (PAfddle) (Lzst) Data o�Birn <br />