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f <br />Complete the following for the mflDflflfit <rf ^ above^iamed business: <br />a.Data of Birth <br />Homo Phone <br />HomoAddroos <br />stock Of olMW o' offtoers or directors of a corporation.) .Al. No--------Yes. <br />If yes. describe the changes and the date of City Council approval of these changes? <br />Since the date of the last renewal appUcaUoT^ (This i <br />day operating decisions of the premises.) _,2L_ No;Yes. <br />If yes. describe the change and the date of City Council approval of the change? <br />»"-----------------------------------------applications which have not been submitted to the City? <br />If yes, describe these changes and/or Include floor plan <br />Yes. <br />If yes. give details. <br />3. <br />If ves. attach a copy of each summons received .«v <br />r <br />Applicant and --'-"k: oilrj.^:?ro^:of::i™!o: ^rpeic*::. iXof or <br />ma. I hal read the foregoing gueslions and .ha, <br />the answers to said questions are true of my own know'edge. <br />» . <br />•• .. • • <br />> a • ’ <br />• / <br />Have you received any summons during the past year under M S. 340.95^ (This is a claim for injury <br />rw-Jiting from the sale of liquor filed under your dram shop insurance.) X- ---------Yes. <br />• f