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THIS TRANSMISSION CONSISTS OF 3 PAGES,�ICLUDII�TG THIS COVER
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� ��9/1�/2008 02:05 952-401-1629 BALTIC MRTG PAGE 02
u611�:!:00�1 �L�H�) 1;;: 29 i�A3t 61261.7:601 13C� Hoard �010/016
r • • . .. . ..
OISCLOSURE OF COMPANY OWNERS, PARTNER.�, OFFICERS
NAME OF SAION:__,�.I�l��{ _ r/F�'S/�/OMf ._..__._..._..._ ...._
nn applirsns for a 5abn license must Include the fo�lowing inforrt►ation:
. Indlvldual Proprlecor; Provlde the name and address of the Owner
. pennersMlp� Provide tt•e name and address of all General Partners and llmlted F�rtners
• Corporetioa or I.LC: Provide the name and address of all elocted Office�s,Directors,Gov:mors,Meml,��s,
Shareholdwrs owning 10l6 or more of company stock,and aoy NWna�rs/Employ�:�s
wRh authnrlty to exerclse corrtrd in poli�y or management of the cc mpany
11 ahv OWnl�o►ycRne��s�lso buslnass en�iry,ypp mw1 r»nplek khis fartn to disdose eht awne�s/portnets/oNlee�ilueehaleers�f ehae busMcss enlny as well.
Last f�2rne First Name Middle Initial �^
�R�s��s �u�,i� �,
Resld�ntiel Address Primary Telephone Nufrtber
a i 9� .� /7��� c oti��- 8� �� 9�a= �r��r-��a�
City State Zip Cpcle •
�X C EL 5 i0 /c' /�i'� 5s" 33/
TiUe(sycrk une) � T
✓ 30076 Owner General Partner umited Partner
_„Ele��te0 OfJlc�(title:�„�__� Dlrector _��L�GovernoNMember
Sh,�reholde�(na�centage af pwne►shlp:__96) Me��ger/Employec with tooKolling a�thority ____�__�_�`
Last Nar��e First Name �� Middle In.ti�I���T
Re�id<�n�ial/kidress � Primary Telephone Number
CI[y W� � � State Zip Lode �
Title(�l�e�:one�..._..-- —...�..•--- ---- •
...__1(�OS6 Uwner � Gener�l Partnsr �imited Partner,
�'I•+�iRci ONlrer(title:___ ___,.) Dlrecror LI,C Cpv�mqr/Membrr
____Shareholder(Percentag4 of�wnership•__,�,96) Manager/Employee with controlliry;autho�ity '
Last N:�me T �� —,-••-�-___._ Fi�Name Middle Initial �
_—�.._...�—.�,
RP;idem�a�Address Primary Telephone Number
City—-------• w.M�__ — Sta[e Zlp Code . —._.
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T�tlQlrh-c,1�ne1 _...:,«......_...._.�..r—_._..-• —•------.....__..... ...�.
10�9�Uwnci Generel Partne� I,im�[ed Partner
� :'I«�.�n�1 Uff'��er(title;__,_,,,,�____ ) Oirecto� ll.0 Governnr/Memb�•r
yh.�rF:holder(Perconta of Ownershlp:__%) MSnagcr/Em lo oe with�onhollin auMorlt
---•----.. ._�._— � P Y 3 Y----
This form may be photocopied if additional forms are neec ed. �
� 09/15/2668 02:05 952-461-1629 BALTIC MRTG PAGE 03
06/1=!300� eHU 13: 29 [+AX 612617�601 BCB Doard IQ,�ul,l�u.o
Buildin� nd Zoelne Comoliance
Check the appropriate box below,and attach requl�ed documentatlon: J VL /l�ll�/ /1/�/R �/tsHro�vS
(Appllcancmust check one) � 3 yy 9 SHOR�i�iN� .��
. 7he building In whlch this salo�is located is new construdion. . �/1!/��R� MN S S 3 9,- -
1. ApDlicam musc eaa�h a copy of th�:signed,dated LeR1Aem ai oecup�ncy issu¢d by the G5e'or Co1�ntll In whiCh ihe huildi��is
• located.
2. AppI1Wm:must aLtach siatemeM from Zpning Offltlal Thai 581on K in compli�nCO with zoning Ordlnences,or obtain s��r+atun:below:
Si�neture of Zoning OFFicial Tltie Date
Print Name of zoning Otficial Clty or Counry Name Telep ione Number
_,_.._.�1'he building In whlch thls salon Is located Is an exlsting building. The Applican�has made improvements
ar changes to she salon which requlre bultding permits aod zo�ing approval,
1, Applicanl mu�l altach a copy of the Building Permits issued by thp Ciry or County ir whlCh Ihe k�uilding is located.
2. Applicant must attach stateme�•c from Zoning Official that salon is in rnmpliance wi�h zohing ordinancps,or oh�ain
signatura below:
7.
5ignatur�qf zoning . � � Title Date
Print Name of Zoning Official City or County Name . Telepf one NumbEi•
_r_�he building in whi thls salon Is located is an exlstlng hullding. No Bullding P•�rmits or Zonln�Approval
were requi he �ty or County in whlch this salon is located.
'��
���, Pc�n�•✓ �v U� �-
' at e of Z.oning Offici�l ` TTt1e Date
--C"et��TY�¢✓ OronG � 'Z�t�r - ��Z3
Print Name of Zoning Offi�ial� Clty o�County Name '�elepf one NumbEr
... ..._.. . ......... ....-- -.. .... ..... .. _..----- --•— —..,..,._,.r. _
Oirettions ko Ssbn Dr�w s Dlagr�m to S�lon
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