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rI <br />t <br />b ‘ <br />Indicate below rh^nfgi at forporat^ offTiffw. partngr^. home addrwstt or tclephongLjnunib^ra: <br />ry,; rtr>~\ 4^_fo^S3C_______ <br />Pn , f Jr\ (THcf, ■‘Vy ’c S" yrir tA <br />iCA^hlPFiA^r^. '. 4^^-ir^e.i <br />below det ails of liquor law violatiom (civil or criminaH that have occurred within thf <br />last five years. (Dates. ofTemea. fine^ or other penalties, inclndiny Liquor Control Pfnaltif»il- <br />Report below details involving any license rejections or revoeationi. <br />City/County Comments: <br />, I'J,