HomeMy WebLinkAboutAgenda Report - February 2, 1983 (24)KK
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APMICATUM FOR, ALCONOUC UVERAGE UCENSE(S).
1. TYPE(S) Of UCENSE(S)
FILE NO.
Tor Department of A coWk : beverow Control :
RECEIPT NO.
1415 0 Stn.l r
Sanenlq Cent 95814
ua958
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Ftl ;
RA�PFfICAI
f i Y T} F� 4 .a.IpeMKteeMllNtOCAfrON) .1. ..
ear x/�
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r4
183
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.Mreby appow fpr
1Ae.wid�rstYned7.
tkynses dr$cnbed
�l ,
z NAME(Sj-.OF Ai•Fuci►NT(s)
Applied under See. 24M ❑
C TY QE !ODI
mm
Effective Dote, betas TJ tle
Effective Date:
3. TYPE(S) OF TRANSACTION(S)
FEE
LIC.
TYPE
$
4�
100.00
4. Name of Busin*n
-%m ilrm- mss
S. Location of Business—Number and Street
9 me o inset
City and Zi p. Coj;.SW WA 8118 County
TOTAL
S�41
6 If Finalkes Licensed, . 7. Are Premises InsW*
Show Type of Ucemei City Limits?
S. Moll" Address (if different from 5) -Number and Street Revert (ren,)
X91
9.. Have you ever been convicted of o felony? 10. Haw ns you ever violated any of the provisioof the AkohoNe
Beverage Control Act or regulations of tM Deportment per.
Coining to the Act?
r
1t. Explain o "YES" answer to items 9 or 10 on on attachment which shall -be deemed part of this application.
` 13. Applicant egvees (a) that any monoga anployed in on -sole licensed premises will have allthe qualifications of o EoenMa:- Oita
,b) that he will not violate or cause or permit to be violated any of the provisions of the Alcoholic Beverage Control+Act.
13. STME O! CAUFORMA County of Sm Dote ..- --. !l
3. tt.t.r w 1 .t:y«M.v..e.s p— .t— ar..a» ov—. bo". ..%f— end ».. (I) IN k rt'u� n.�h.�1ta.M, « w .t �. •orN�+•�M «eve e..riN.t
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e.tee dee Ml.e'�.d-s...1. rte •...a.r. e.....1 ...d rtes .e.A ..d ell A rA. a r...e..r. .Mr.lw .,.M w rn.es, t2) r1nl ee .w..• .r11..�rti.w• d.e .etrtMel -
y « oppftw^ wM eM A«s « $name k.«eN fe . Me "oncewr's « eeotke v fwniMr. M M ..Ad..sr.i ..wdw ,M n.....(s) I« ..I to e.l. ytllMrhq M w1.iy t -
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14. APMCANT
SIGNHERE " - ...,.... _....... _ ........ .... _ ..... .-- ........... _.. ...............
iG
n
APPLICATION NSfEROR r
S STATE OF . CAUFORMA County of _ .. :. Ovte .... '� ?
:: j ver» ewtry t +e .«es es..« .I«.:is.;.o.; apo � ww.....«as.. «a »r« est rw.r o: tt....:: «..«ws.*
' (,, e...e rp4e» .aen MMe w.Mt.r. 4eu�.!►. d.t1 «rt.«tw 1..—&* *4 ft.-sw e/ a -do.., « 6% rd.N,: (t1 naw .voww.. s., ..rr..d«
Y. eM :t s.w.► c, ls..««wd aw•..W d....it ti.twr 6" w> ...c« ver r. e..Mr w ..r r w.w+.
eUdrM.dN M �eM..ed t.►;,e.e:tMr«r.rst� rt.«' IM'MMIM:.�/Ik.Y.w ✓ Feeered"""MMtM it eM e..i� b e�ri.le rlrter+..wr .1 e._Mefr M N't.INt -•.'•
M-er..eMM eele,.d i,.y r..re rtne wiMr MN M«.�M dr der M •rAkA rA. - MMI« 4 ei.i ri1ArA. « M M .Net,illt/ e, .
erellM.e M «,7« .er p.di1M .1 MMl.r.r « Mdlrerd-n.d1M et MMh.«r {e1. MMM .MFre1M. veer M .dd.dr.1,N1 �,eterr the
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Qlgine(si of lieerlsee(s) 17 natures) of:Ucensee(s), 18 LicenteKVs.—
Ax;. AGUVA14
IRS" Ow
+Y. - 42
10., tows" 4~ Count, sea asomin
Do Not Write Below Z'atie Line; For Department Use Only
Attache& ❑ Recorded -notice.':
❑ Fiduciary papers,
"0 COPIES MAILED
❑ Renewal: Fee of Paid at Office on Receipt No.
•nc 211 t.'.n nJ In I" 18121X1:11'I GA- MI