HomeMy WebLinkAboutAgenda Report - October 5, 1988 (51)(0
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1 Ds wat dstxA—Rsrrrw ati sepiss Do Nor Write A"s o rAir ti"—for Hsodqusrtsrs 015rs Ow ty
APPLICATION FOW4LCOHOLIC BEVERAGE LICENSES)
1. TYPE(5) CF LICENSE(S)
ME NO.
To: Department of Alcoholic Beverage Control
RECEIPT_P:O.
1901 Broodwoy
L/ /
Sacramento, Calif. 95818
OFF SALL E= AIS WINE
GEOGRAPHICAL
i onrewr senvrwc ;oc.nowr
CODE 3902
The undersigned hereby applies for
Date
licenses described as fo&-s.
I
Issued
Temp. Permit
2. NAME(S) OF APPLICANT(S)
Applied under Sec. 2404A [?
T-58957
S�5&S . Cr. Hca' y ,T. I.T hrk R-
Effective Dote: y t i? ± �,
3. TYPE(S) OF TRANSACTION(S)
Efiec ve Dote-. t 1 _17—p R
FEE LIC.
TYPE
b
Parr
n
:. Name of Business
Sass' Calfiornia Cxxmnet Meat- r. n --Ii
S. location of Business—Numberond Street
620 S. Central Ave.
City and Zip Code County
TOTAL
$
San 95240 _
r- --%
..COPY
De not dwrocA—RNwrw eN aepiq
Do Not Write Above This Liess—for Noodquarfers OIRce Only
APPLICATION FOR ALCOHOLIC aEVERAGE UCENSE(S)
1. TYPE(S) OF LICENSE(S)
FILE NO.
To: Deportment of Alcoholic Beverage Control
RECEIPT NO.
1901 Broadway
S.f:.
Socromerlto, Calif. 95818
' ::
�.. • )e- Beira awf .rw "
GEOGRAPHICAL
IOIeTRICT aLAVINa IOC,tT10N1
CODE .• .39OZ
3V
The undersigned hereby applies for
Dote
licenses describedas fotloe,s:
issued
Temp. Permit
2. NAME(S) CF APPLICANT(5)
111111
-
Applied under Sec. 24044
'
Effective Date.
Effective Dote:
3_ TYPE(S) CF TRANSACTION(S)
FEE
LIC.
TYPE
S.J
...r .,,
rf.i i i. ....
,, .::•ii
u
A. Nome of Business
SLOP ly, i-iarket.
5. Location of Business—Number and Street
42') Z;. NcAtlesiari Li331e3 ,cite B6
Y � Y' " 1
City and Zip Code County
$ SO
TOTAL
-0 r
f
I
j
i
6 If Premises Licensed 7. Are'li remises inside
t z Show- Type::of License i 21i City Limits? Yp8
8. Mailing Address (if different from S)—Number and Street l7.mp? !►.r n)
fSy'1C 34z i E :l+dv. $�CaLertr$g�tayrf' "qi Sam-'Pprm
9. Hove you ever been convicted of a felony? 10. Hove you ever violated any of •the provisions of the. Alcoholic
Beverage Control Act or. of the Department per
NO taming to the Act?
! 11. Explain a "YES" answer to items 9 or 10 on on attachment which shall be deemed port of this application
12 AQplicant agrees (o)'that any manager employed In on sole licensed prernisei'wilt hove`aft the quah►catiori3`of a licensee andFyr
(b) that he will not violaie or cause or permit to be violated any of the provisions of the Alcoholic BeverageControl Act.
13. STATE OF CALIFORNIA County 'of--•---c�'�n-, �T----------------Dora-----��Z�
under : ponalry of , is dwy each person he. .19—tar. ppea s below. and toy(1) He is the applicant. one of she applicants, or o e e< t
ti ..:..- 'r7L'""�.-'v?d'�Mi'relFeei?'v! slit% bpplkent co�pS617a1^''Pewiedwirr ehfi+Fwapeinly,vp�Pticat otl.•k+doy'G ouMaiNda;fe'moke,,ll.ia'opplrptiM on. /n;; i,>•helfiyl2t 4fhot M M«:nod Ihw ,fwe� '
...
poina apPbcabon' and knew rhe C-4.1. Thereof and IMI' eosh� and otl bf ' IM Hotemrnh IMre:n mode ere true, (3) Thor ere person eller then' fhe oppl <aM
or oppPconU has any direct or ind'rr•<t (nrere I in tM oppli—l'+. w eP01-11' business to be—d.cced order he lk—.jo far whl<h this opOicatien it 'mad.,
(q that IM transfer application, or, proposed hanshr is nor erode to solishy. the. payment of o loan or to fulfill on agreement r reed into more than nliewly
{ T, +fer oppb<gtien i> filed sy M IM INpq rm ratan; to join •slob1i,h a preference to or. for;of,s any -ru!rortran>rerw ef'te
;f dopa, procedtnp M� do M hicA ill t an..
>y •defrood er nPwe. any credtor.of ha oi,or. (5) that .the Ifalnfer oppt catwn maY M rhdtq n by eieM rM Pelic 1 o rhe'fr<e t1i tro rewllrnp�tretl7t rye'{ „icy A't -�
.,ill' D•Po"menl.
14. APPLICANT
SIGN HERE�r --------- - -------------- -------- -- --
r
APPLICATION BY TRANSFEROR
15. STATE OF CALIFORNIA County of._ __s Al IQ bl3I------ --------Date--'--.'JJQ_2,f2"M -,-
-uwder penalty of 'p. iwy.'wtb Psr+oss '.WAme signature oppeera'•befo eNfre> nd"sops; ft1 He't> ehe t<e 'sac;{a on. "clavi • o1Rcer�':of tM at. r. rwmod w fl*: farogom9' Irondq opplrcotton, defy" wilMrired • Ie mak. this Ira +for,. applkarron o its beMll (3) Mas M , "Is make+: vd coHen;'. to awrMda
I ,ell inNrnt in rhe attached, licMNlrt d.Kribid b.foW and to transfer se— ,Ioi the *polleant, ond.'ar � IaroHM indicoled on the upper `pareren of" Mrs epyli<asien
farm, if iucA transfer is clPF—ed by the a octos; (3) shot the transfer epPlkbt er popesed t-04 s not 'mode to Set'
ly ell payment of o loo ,� a so fuMtl
ogreementinNred erre. mare then vinery' dogs, peceding,,the day a hick rhe Nnn>fer opplsio/:on 61srL. Ili Me;'Depgnment erg aYw..Pabl
on, v
pnlerMee to ar, fed any'c q&br of konsfirar er 6 defrosrd tot Tyle anY c edstor o! tro sfe a !el Mel IM ton far opPlNolsM� moii'b�.: �'Mdrewrr!'.'b'ly
of+Pliepnl ar Ihq.;,l(rinseer Ili ,!tq rNaltkw 11aMlty'b„Mp a•porhneM.,R
'.
! ld Names} of."Lieeilsee(s). '. 17.' Signature(s) of Licensee($) 18. bcense'Nvmber(s)
�,, Atzilicl A ' ISfidff 2i5 2
J J
4 ` i R \ Fi<t1 Fly, J ! ` 3 ` • 'd4 l.r\ ./
y 1 � I I f i•
i9 Location " Ntimbwr artd Street Gry and Zlp Code '' County #
�f
:
Do No . t Write Below, This Line; For Departmsret Use Oaly
Attached Recorder) nohcer <
� � i �'; c, � ,. - F•Iduetary'popers v,^ < r}' '
----------- COP ES MAILED -- --- -
., — J.ta.h. .trsrw .11 envies
Do Not W...• Ab... This Lige—for Me.dquortert ORtee 0.1y
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSCS)
1. TYPE(S) OF LICENSE(S)
FILE NO.
�- - --
To: Department of Alcoholic beverage Control
RECEIPT NO.
1901 Broadway
Sacramento, Calif. 9581$
GEOGRAPHICAL
tor.TRtcT.anvtna�ouTroMr
19 locations�s Number and Street
CODE 3J.;".= .
The undersigned hereby applies for
Date
licenses described as follows:
Issued
Do NOtWrite Below This Line; For Department Else Only
Temp. Permit
2. NAME(S) OF APPLICANT(S)
Attached Record td notice
Applied under Sec. 24044 [1
--
„.,.:.�-. .._... ..........:.t
Effective Dote:—
Effective Date::--:i.•-t.=
MAILED
3. TYPE(S) OF TRANSACTION(S)
FEE
tic.
r
TYPE
20
?F' e- Cr -7j Dt 4420. 5;e5,
4. Name of Business
vise{: Iil i'icr \e'C.
5. Location cE &sinerr—Number and Street
2; L. �:'tt ti :s n t,:�r Ste. –b
City and Zip Code County -
TOTAL
S
–
TJedi 9r'�1�3 airs .To:::ain
f.
e )
1 6. If Premises licensed,
7. Are Premises inside
Siow Type of License 20 City Limits? yes
j8. Mailing Address (if different from 5)—Number and Street
same Ferro
9. Have you ever been convicted of a felony? 10. Have you ever violated any of the provisions of the Alcoholic
Beverage Control Act or regulations of the Department per
`j ZOO raining to the Act? 1,�
11. Explain o "YES" answer to items 9 or 10 on on attachment which shod be deemed port of this application.
}2. Applicant agrees (o} that al,y manager employed in on -sole licensed premises will have all the. qualifications of a licensee, and
(b) that he will not violate or cause or permit to be viotated any of the provisions �of the Alcoholic Beveroge {antral Act.
STATE OF CALIFORNIA ,
County
' a. �
Coun of .:. `l_s��it�St--------------------Dote---------�"- �-t�-----------
13.
Under penatty of P.ri.'Y, each person who- s;g tori appearsbelow,. rertifiet and says: (1) Me is the applicant, or one of the oppl;conrs" or an ..
of&a of the oPpli.... ...por.tirm, named in she foregoing oppt von, - duty oNhw:red i make this opPGcotio" on its behalf; (2) Thor 1 e hos hod rhe t {{
go;.g ooplimtion and knows the cenrenn thereat and that each and all of rhe sra,ementa ,M1erein mode are 1—; (3) rho, n person .,he, 'hors the applicant - f -
« "pplk.n,, has on, dime, - indie l ;.rerestin tbe oppIje ,*. or apyficami bvsi.ess ,o be c..d.,I.d ander ,he N sets) for e h this aopplk.l; n ; mode;.
7 (4) [hot rhe rronafer oppI;r ,;— - proposed transfer - of made satisfy the payment of o loon or to falfili on ogreeme+r env .rd ;ne m r Lha try IPDI -
( - do,. W-.d:.g she day on which rhe transfer oPPI( t n s 6ted ih the D p.rrmenr « ro ga;n o esrobnah a preference ro r f« a rrd�o n f f or « t
-, defr.vd o iniwe any aeditur of "o-f-ar; (5) ti." the transfer ppi "tion y be w:rMrrawn by either the epPlkont or the olicense-^ iih n salt g 1 lt;i;fy r
�-
the Deportment. —
14. APPLICANT
Y "
SIGN HERE'V T -------------------------------------------- ----- -- -----
,s
APPLICATION BY TRANSFEROR' `
IS. STATE OF CALIFORNIA 5:, County of--Sa.. A -== -------------Dote-----1-----------
15.
1 - ${3------ ---
. -ami
Under penalty of PHi•rY, wch person M • siyrolwe_ epprors Mlovr `c r r and says; 01 Me the Itcm « "one «ripe eifi - ! ,he c p Nslke r
named in-,fhs� lorego;np jronsfsr opphcot oq.: duly' aarhor)ted'•maks thi t infer-appl ofion'o 1r bek.lf. (2) than he hereby moo appl:<.r I-
1. wrerder _. _
-' and. « I "viers- :nd:cared on rhe .PPer pornon of rh a ' oPPfi< r
• , . "tt
interest :n. rise oriothed lksn-(s). d.xr"bed "belay rind to,. trader wins to rhe-`appt' t
--: proposed. eransl - r made eo-.we;sly rhe Por o ;. 1 r: eco falfll s.
... _ fd.m, if.. ods hon fH ;,rs W'ted tsY'.rh O;r.etor. f7).rhoi:,the transfer=applcolion,w m f
F
ogr.emehf enc rid info; mors than nrmty, days precedirrg;,the day m� hich rlse r Fer oppl .nn .s 61.d 'rti. .the Depo.,msn, to .gain robl;sA
prererersce
so or lot_env. c,"W.d hanaferw or ro defraud or., ntw. mr . editor of. h F (4) a 'tr ter oPPI: oriin may W .hd.ow by ,'her rhe J
_ ...Ppptrcorrt artlis t mass. with iso wginy 1 6 t ty fp tM U partmsnr-y tic
16 Nome(s) of Licensee(ii) 17 Stgnoture(s) of tfcensee(sc$ license Numbers}
Atiiiiad A. iGfiAi�P / ' r 20-021562
.Y
}
19 locations�s Number and Street
G and Zip Code
tY
County
S.�
?i
Do NOtWrite Below This Line; For Department Else Only
Attached Record td notice
L
FI uctc pa n t
i�
�- 3- -_
r
i ----_COPIES
-----
' - fOTMCRi
MAILED
------ - ---
r
(OPYM wN iMo[A--{lN�rw slf soO7of
00 Nat Writ. Abor. TWO U —for H.sisdg ,tors OA.. only i
OF LICENSE(S) FILE NO. �
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
1. TYPE(S),'
a2+sr x .) j !
•- "•. l � C+i [>: i:���s
To: Department of Alcoholic Beverage Control
1901 Brood -ay
Sacramento, Calif. 951518
tgt-RrCT e[RYI»a IOCATIO»1
3
RECEIPT NO.
= i j -3
GEOGRAPHICAL
Date
The undersigned hereby applies for
issued
licenser described as follows:
4' ff Premises Licensed t 'j` '- T Are'Premtse'Ensrde�* °
Temp. Permit
Temp. Permit
2. NAME(S) OF APPLICANT(S) „
Show Type of License 42 City Limits? yes
Applied under Sec. 24046 ❑
r
i 8. Moiling Address (if different from 5) -Plumber and Street tT• nvi f►erm)
-a
Effective Dote: i
Effective Dote.
3. TYPE(S) OF TRANSACTION(S)
_
9. Hove you ever been convicted of a felony? 10. Have you ever violated any of the provisions of the Afccholic
FEE UC_
TYPE
Beverage. Control Act or regulations of the Department per-„
' taining to the Act?
11. Explain a "YES" answer to items 9 or 10 on an attachment which shall be deemed part of this application.
12. Applicant agrees (a)_ ;that any, manager employed in on -sale licensed premise: will have all the qualifications of a' licensee and
j (b) thai he will not violate or couse or permit to be violated any of the provisions of the Alcoholic Beverage -Control Act:
4. Name of Business
13. STATE OF CALIFORNIA County 'of ____1_ st1Lt1�3 ------------------Date__=2_d1i
Eta PP.x
' ---
}
l
5. Location of Business -Number and Sheet
S1 IN. Slrr�l
City and Zip Code County
S
3
Urn utn
TOTAL
535 50
4' ff Premises Licensed t 'j` '- T Are'Premtse'Ensrde�* °
Show Type of License 42 City Limits? yes
r
i 8. Moiling Address (if different from 5) -Plumber and Street tT• nvi f►erm)
-a
Perm
9. Hove you ever been convicted of a felony? 10. Have you ever violated any of the provisions of the Afccholic
Beverage. Control Act or regulations of the Department per-„
' taining to the Act?
11. Explain a "YES" answer to items 9 or 10 on an attachment which shall be deemed part of this application.
12. Applicant agrees (a)_ ;that any, manager employed in on -sale licensed premise: will have all the qualifications of a' licensee and
j (b) thai he will not violate or couse or permit to be violated any of the provisions of the Alcoholic Beverage -Control Act:
13. STATE OF CALIFORNIA County 'of ____1_ st1Lt1�3 ------------------Date__=2_d1i
Under p.nolfr of P.ip»r, each person whoa. s:gnolvr• appear below, 61".. and soya: (1) H. rh. opphmnr, of 1h. npplm or ,.
clot
' ---
ofrwr of this oPpti,..k «Npo,ol:on, rwrn.d in rhe f—itaing oppl:cation, dol, oarhoria•d r make 'hisopvli<or:on n iris behalf; (2) that h.n has recd rhe
- -
going appGwt:on and kr.owf rhe conHnra 'It—f and that each and .11 of rhe .rorem.n therein mod. ore troyc t3) ehot no person other rhos Me 'PPl:conr
- oppik-M, has any d;,-, or d .cr iM•r... :n rh. oppli—l', w oppl:conr: b.,;n... to be condaered Dade, th 1 ,1 f h,h thispp+notion t ode;
1
1 (Q that this nonafe ppl ion -o w P sed troasfs, i m nod. to satisfy he poym,M e1 a loan or to f.lrtl o g sne 1 d into thin ry i9o)
-
{ .dorsa —ding rhe dor Asch the r a/ ppl Yo Fled with the. Depa mens or to ga ar bt A a F.—ro o, f cred'rer of t emfe. r
d.f,..d d 1 re any < .dila, of Hw ff : (5) hot 1h. r sf•. oppl cel:on may be w:rhd,a by .:rhe th applk. r rh. I wrtA Ir , g 3 41 ry t
ilft
rhe D.P_Inn M. '.
14.. APPLICANT p
�'!C`
SIGN HERE -
S
------ ------
. -----------------------------------------------
--------------- ---------------------- ---•----------------- ------------ -- -------
----
APPLICATION BY TRANSFEROR
15 STATE OF CALIFORNIA Coun of _ ______ _ ----__ _____ Date ___ _____ -
- U der "penalty. oi,.p. tory cods Pinson who s gnotwe oppwrs -bit rt•fves d wys: (1) H. is rA 1 see<u+ fFcer of rhe <erpo.ar 1 rosea,
_
rrom.d th. forego g r afar Ppr' Prion duly o.tharin.d 10 rook 1h »o i applk.l on its beh if (2t shot he her by kes; oppl atioo:_to w ender
-
;.W -t. in. the enoch.d I:c•nae(s); deecribed I .- -and ro Mans&r some 10 - 1h. opolkunt ad:- levet an .edrmr.d en A. vpp.. portion of this oppttcadori _
f - `-
if such vonsler is by the . Dintidar, f3) .thai rhe Non br; app)i-iion or propa»d Raster is —1 mad.:1. satisfy' this poyn,er» of 'a loan' or to MfiG
.
-
.approved.
. .. entered to mora than ninety def insAn the, do _
an'ogre.ment . h Y w q Y eq; which, tiro rr.rofn opOsorion is: fifed with'th. DeparfineM e.: ro-'gain
n
piefarenco to or fw pny-cred'itx of, RansfMw or ro t4irovd at ' injure any widiior or ,»eMfirw;-:(c) 1ho1_: this Ronif., opplicorion may. b..;,withdra n by ei,h.r-
... ._.._�....._ applicant w. Ihe..I:censee. 4h. ne mull:rrg.il:ob.I ty. lo. rM. Mp?,M!.nt4•y .... :.., r.-_... s _:.l ix.:,' .�- - c`:-
-
..
1B. Name(s) of Licensee(s)' "^' 17. Signat•ure(s) of Licensee(s) 18 Liven"se Number(s)?
Y
-
S
r.
` 19 Locotfon Nuriber atiii Street City and Zip Code County µ
3 �
Do Not Wrife Below This Line, For Department Use Only
Atfocllen�Q Recorded notice F
-. ❑ Fidudary popenr i1-2-1iu
+
❑----- -_-.COPIES MAILED ---------------------------------------------
--r
F Renewal: Fee of._ ---------Paid ati-__--�- Office on ltece3Pf .N° =�-
-,M
COPYOO wM 1MacR-1 A� vrw plt aopiss
De ►tor WriN Abates This Vas -for H*adquertors OIRtR owfr
APPLICATION FOR ALCOHOLIC BEVERAGE LtCENSE(S}
1. TYPE(S);OF LICENSE(S)
FILE NO.
To Deportment of Alcoholic Beeeioge Control
RECEIPT NO
1901 Broadway
Stckkton
Sacramento Calif. 95818
l WE,?, MIMEMV, EATTi�r
GEOGRAP�fICAL
rO1eTRIGT eCRVINa tOGATlartr
x'IJAI_'S
CODE 3902
The undersigned hereby applies for
Date
licenses described as follows:
Issued
Temp. Permit
2. NAME(S) OF APPLICANT(S)
TSSLia71 ^
Applied under Sec. 24044
lv +' :v:3,A. i'.: 51 (c�'12)
Effective Dot-:,\ W=a .{� e? '"�
EffectiveDale:
3. TYPE(S) OF TRANSACTION(S) '
FEE
LIC.
TYPE
S
,;;IGTNIAL (Sea Rice 437213)
�-
47
„rn•:;a1 ;=cam
S�CU.UU
112 Pro --rated. Fee
A. Nome of Business
Yrrn'
5. Location of Business—Number and Street
233 S. SC110o1 St -
City and Zip Code County
S
T mss.
TOTAL
1 yU2U
d. If Premises Licensed, 7. Are Premises Inside
Ci Limits? Tj
Show type of License 41 City yes
8. Mailing Address, (if different from 5)—Number and Street (Temp) ;Perm)
1 116,'i't-ificrt 11i'_y Editer f'ity- CA 24404 arta
9. Have you ever been convicted of a felony? 10. Have you ever violated any of the provisions of the Alcoholic
f Beverage Control Act or, regulations of the Department 'per- 1
r! A ^ref^ raining to the Act? ,1 {
11. Explain a "YES" answer to items 9 or 10 on an attachment which shot) be deemed part of this application
12 ;Applicant ogrees.(o) ;that „any manager employed in on -sate licensed' premises will have the qualification of a licensee and
(b) thae he will not violate or cause or permit to be violated any of the provisions of the Alcoholic Beverage -Control Act-
13. STATE OF CALIFORNIA County 'of ------- Sl3-,3Qaq111ri--______________Date_______1Si_227_$$_ ______:_.
ander penalty of porjwY• ac6 person whoa signoNre appews below, ert;Ae and says: Il) He s the opplrcant; of the oppl -i",� evtrs.
off er of the oppGcanr corpwarion, named in he forego:nq oppl;co8an;'dal,-o tho6zed to make this oppik,tion or, ;K beholF; t2) that he •has orr ad he .Moro
-' - going application and krwws rhe contrasts thereof and that each d 11 of. the sfafema s lh ein de are r (3) rho pe on other than h
ce applicants hoe any d4ect or,, ;ndireer inrxe in I. applicant's w PPlrconri bus:^ess T be onducr d. under IN. I sI f -h;,h rlws apoli<o oda; I`
: (<) that the r ons ypl of; p, -.sed sIronafer ar- made t satisfy +a paymentof loon to fulfill agreement ed to a than,ty 100) 1
days p .d g the day, on wh h rhe transfer application s filed with he Deportment w gain w establish a ptf a to f ed.f more
-.0— or to
defraud 'w rnivre Y cred;f- of 1 nsFerw; (S) shol Ih osier oppl hon may be. w;thd by either IN, oppt r ar he license. wrrh ewlr; q 1 bilary to
the Cepa r r. 3 - -
14. ; APPLICAt.IT r ; ?
SIGN HERE : h =-----' ` °-- --- -----%
-_----___-__-_______- _-__.. ________ ________ _________________________________
_ — APPLICATION BY. TRANSFEROR
15. STATE OF. CALIFORNIA County of ---- -- --- ----- ------ — - -----7-777-7--------
Dote
Un4r penally of pts W y. each pe ..h aryrra:we wp.n bel. 4 and -1--,(t) H it Ih e Miceits.e, w o cze t officer f therp 1 censea,
n
in the foregoing L.nsfer appfs .rine, dvtY authati ed to make this namFn spot cstron - ;fs beholf:. (2) that: he ` hereby make,,application » s.rrrrrder
all int....i-in the. attached Kzen e(a) 4..ib�d below and to:Iron f e.I. the applicant and:w lac . ind.oared en: the upper' porr:on of. th apt mrion
'form„ t such transfer, n gpproY.d by. rho, Dwecrw; (3J that she tr sf ppli r w wap sed ".If net _nwdr t I;afy th. payment 1 too ro fvlfrll f
en ogre.menf east d te'-roar. Ilan ;maty day. p—durq ihe- day owhich f- i pptk.t;- filed ah tM D.p.rtanenr w t gain; o t b!ish a }
... .. peierenz. Ia.. or_JW r r i b si it) -rear M nonsf ppl at may be ehd `by the,-tM It
ed.iw f r. f. wee -Def d w lot" y c ed:_
epptic f w She I;c ware rot wlnrp-! bit ry-Ie r6. a parr^re^t Si natUr -A V•� - I ,
16. Name(s)`of liceniee(sj g e(s) of licensees} ber(s)
_...
13 License Num
$,
� 4E
T f J
..
K
erre, ._ � •erre
M >
Location Number.ond Street':' - City and Zip Code "County
z
Do Not Waste Below This Line• For Department Use Only
Attached =j"Recorded notice
2 t d
Fiduciory papers,
❑ ---- ---- -- ----------------- -- —COPIES MAILED
tornur
Fee'of _=---- Paid