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HomeMy WebLinkAboutAgenda Report - November 4, 1981 (33)qq KA NO; INS, As a- MW Lw QWQ - Vd-- O Y a ... +�N�-# i an a1"i to NM Mtii 4 TW Use-Fw M.J,.er»n O1Mee 0Oy x e �� ,,,lllcAfloM coal` ALCOHOLIC: NAVIRAGS LICp)3<t(s) I JYPE(S) OF LICENSES) FILE NO.'' rest DeporMt of Akoholic Beverav rAotrb(_ RECEIPT No anMW{ 40pmneMq, Cnliif. 95814Milt GEOGR/1Rti1CAt. , , i tow. s� Tb wlderskned hereby awm for =% r s ;a < iia!aa fletHibed of follower - illwrd ' �Sx� y �:.: Tom. Perinif ;;J `�'� �: �-x'li trllAAEts) Of MF'UCANiiS) Applied: under Ser. 410<4 �'- - Elfoellw Dow Effective Dater 3. TYPE(S) OF TRANSACTIONS) - n - w; S r _ �T � � •s. .'t 3 Hrme of Business- 4 - . Locallorrof W49ness-Number and Sheet ri s: and Tip Code County _ 1� TOTAL �� r lUpmaiises.Licensed, ?. Am Premises Inside $hewTjrpe.efLicense. 41�11tS86 �ta ►e T1Y.� City'limits$ 8 ' MdBrq Address (if diFfeterJt from 5)-Number and Sheet T. 9 Ho" you ever been vmvkted of o felony? 10. Have you ever violated arty of the provisions of tM Alcohotie f Al,Beverage Control Act or regulations of the Department Per- s9° l to;ning to " Act? '>-:..11:' Exploida "YES" answer to items 9-or 10 on on attachment which ":be deemed'-port of Nds oppCcotiom „12 Appkont -agrees' (a_) that any manager employed--in on-sole licensed premises- will havo- 08- fbo (y Foadions of a Gcentee. and r ;bj 11sot M awill-slot violate' or muse or permit to be violated only of the provisions of'the:AlwboRc average-tomhat A �. ti 3 a. 13. STATE OF GKlFOAML►' County of Stt>L .iO�ejtifII .f p«irr. ..cb w..•• ..I.eN .row•••w• aggro. b.1... ..r.M.. aN wr.• 111 /1. is *a .pplwawt. « .n..i e.. epplk.Mtk t� .f M .pplk.wr sa.wNlew, waawd in tb. ra•..•k'. applk.6. dA, a„ew:.N »—W..bi..•pJ.tk.N- aM :s W.W M e.o. M t.& r..d+}4 Mhy .••tk«I.n .wd bw.�. war caMN.w. M•r..r ...d .wr .a.b ...d e11 d ww .ro...w..J. ww..i.. wed. «. «.., AI www w •.n... eew. e..M tM .pp:k•..r J '•!t- ,t. 3 m-- v •/pUumft 1a. «.r A r i..d.M k~w iw ow eppiia.M'. « apptkM o Wsiw N b...wd..rod M.d.I JA. IkMr(.) f« ..bi % thk ,fir' t (H Md.M w.wd« .pptk.w_ « PI.P. N w«d« i. wr MMus. ro ..e fr h..erwwke er • I— « ro f.1te .w e.ro.w.wr ..w.y.4.'!� •-••1h.w)•'yAtti,, (�Oi }3.br � r: � E Y .:' as" P.weiM A. d.r w -hkb JI.. wamh. a tke.:aa i. RMd .&b .1.. Dpa..w.wr « ro I.A. r ..ftwhh • P.1w ti r I.r .4 wJrwOw .f Yle.wl.p.r{M.M `a a �s 'Sv-' ^' �JMd w I••I.M..wr u.X.er of New.rw«; IA J7...r rM wamf.. applk.," war b. �:Mdro.,w br .:N..r .b. eVoU- r « .b. 1k.Mr� ;rush she14. APPLJCANT n.prlwlMr. ! J --Le Z 8' J • 1 l :: c SIGN HERE j tr . ._f.... '. _.... _ _ ,...4 �wFe r 10 APPLICATION BY TRANSFEROR STATE OF CALIFORNIA County of _ __ ' r; ,S• und.1 pw..mr .f podwv. veA p.r..w ..b... 4vw %w• a•p.r. ►.1.b. .wells .wd »ru (1) m. » d.. tkaw.... w ...•.e.� .4r. .t .M s«pa.w erre.•.. ' J.... MpJ•.d t• do rr.Wk•e w.w.f« .ppti, -, , d.k . A%W:"d ro w.be •.k Naw./.. "w"MK" " .. b.b.ttJ M *w M bo b/ Mous eppNwl" M wn.Mdw .e' ko~ s► rb..m..twd sour..) e....n.e I .Md » wwM.lar awM... JIy .pVK . * aN,�r 6-s;.w 6&..$.d- w dw apw p sga. J. Wo ..pUmts.. ,..T r«w 1t ad. w.w.hr I• ow—.a y e.. DI—w, (3twa..1« aJrolkaKaw w r-w••e w.wrr« A-w.► wwwM N ..e.ir e.. rr••••e d . l..M «» FrlRti .. eo•Oa•iww .wrw.d hft .w.r. ew..J wkwMr d." P...dk.p JM dN. M ."A .Jr w«.d.r .pplka 1.w i. OW A* yb. o.p.wwww w N r� .r ..roMl l.. • _ �'� y��_ pnJtrMM r fr ...r a Mw .f N.M.r«w « ti d.1—d r . i••ia•. aM pNN.. A- w.w.Mn.f iN JINt JM wwmhr .pprwaK.M ..w7 M aaitbdr...w 17 .sero .A. �„�� �•_ <��� r � .•pplk.M w� tl.M.s,a.�. M a..wl.iq 4.WWr M tA.C.M•J•Mr.w: - "...,' r K r 16 Nome(s) of Ucensse(s) 1Z. 'Signatuie(s)�o l(celliee(i) i 18. Litems Number(s)' i H Yi Mg. 7.: ' Sr 19 LocoMost Number and Street city and Tip Godo County l' .- '�(4 i a Da Not Wrffr Hebso This Lbsy For Department Use Only 4, a tit i Recorded notice. �4 ,r c Q flducicry papers, s ..-....... _.. .. COPIES MAILED . t I.... 14�istF� $ Q Renewals Fee of _. _ _ Paid at. _ . Office on _.Receipt No. ...... 2 $'ger AeC tIJ flap . ` Hutu. JaI7•+xJnc wwoep L`' ..::- cznz-i.—.omen.-��""-._..-,.:--.:.,-.-.:----"'-._�—�...,�,.y.,xu^:;,N"!,�w�.r•I-��t:.:. e; 4aFuy�x.s'?�"ori:�:J'i.�!:c�w�:��.•..•........^' . ZMIWt #N" .. 4acotiDtt of B"iness_Number a11d. ' City avid Tip Code Lou# ". 40 County Stns TOTAL S 76.0 1 c< � x n N /remises-censed, 7. Are Premises Inside xme .: 9�Show-Type of license City limits? 140 5 _ Y` -Ma7mp Address`N dilfe+enrfrom a-Nwnbeyrond Smtr,e,�e.t�. fro") 7> —1 �--1i�. �- Dea�vz ilii. �e iLi 4804 9 Hove you ever been convicted of o felony? 10. Have you ever violated any of the provisions of the Alcoholic - �? Beverage Control Act or regulations of tM Department per• .� a 4: coining to the Act? gyp_ f . t s I. Explain o'rYES" answer to nems 9 or 10 on an attachment which shall be deemed port of this applicatiion s; is 1?�J1ppKeont=ogees 4,o that-carmonaper_+mploy@4 in on -sole licensed pre nines va haw oR the queli6eoliens. ii o ee.�snd r ` M will not vk+late or souse a permit to be violated airy of tiie provisions of the Alcoholic Dererege Control Ad. - 13 STATE OF CALIFORNIA County of t `_.-�. �r " tew/r pPr.Mr .f 'P.rlrr. ..t1i Pw.M wMN wie••r.i. .pp.q .w.�. .wrrie.w .wd wwrwt (t) IN k• er..PPNr.r. r w .t ii..hNrwrw, r M ..wt1iK.. ' ' -...fir .1 M .ePlkrrr rq.r.N.w, w.wwd i. do hr+MMe .PMkri.., dwr .*-i-d +. wN►w d" Is « Ns tr.s.e, *),*.I M f,.w .Md'. Ki. i.i.• .:; .,' .. E981.0,.s'ssr•ri•+ w ►».. KN w«Nrw er...t Md' rlrr .«...d .n J " o.% -m. *-.M ,w.e. w 11.y (3) e..r M o. e*r KN. er "Ok.* lMEN ..:, � 7 k - - weeN••"i• t'•• .wr . dMiaw r Miner MMM Mer ."n w o aPvu..ri irrri.wN N M s«AreMJ wwdr ilr. Nrrp.(wl er w.ikA- Mdw "0', N.. k i C (Q II�r.M tirtM y0)kriM M vmo." I iw wr MN N "at .M v-, Or .. 1.« r to MRe M. wY�M~'r MMwI-1wN ur. llrww4rMr (eq. 0 5 f s>•'= d.rw pw.iwe Kr M .rlr)di li. for M Gtwd .riA rtrw D.►riwNww r N ew., r .wNWkA . Pr.hnwrw N r for «► sniw .f re+nwl.r.r r so _i .. dwFwr/ r Mjw. w T .t - A ik.r �ww.t...wtkw:ww �v M .riiidr.w t7 .iKur rir .OP)kwww w d. Ikwr.r .riiA .r. i.wriuirre. iMMN4 w APPLICANT" - SIGN HERE .. ':Itk ..... �. APPLICATION BY TRANSFEROR S. STATE OF CALIFORNIA County of ... ........ . .... Dote _._ , 7 t "Wer Pww.li► .t P- wrr. -A P— -h— nowt—*:.•P.-s ba-. rriiew .M -vu It) )N k M. Nw.wrw, r « ."mCi- .ekr .1 er uiP.r.N M..to Mok.Kww. &4r ev*ed"d N w.- Ws MMdr .POEM M iN twlrMf (:i' MM M & As w"" PP1k dvR N M,$"Ww on, bd~ M rM e".A d New—we) J wrA d Fwd.. .via N ft. -#.r r.r H Kr •.vNw.•r .ww:r Wrri.w MdkoNd « er vPPr pori.. .t Im int ••" rill froidr is .Pyr w.d b M Dir"mr: (3) iho pep." .Mwhw h nH wi.d. N wwoW *• Mr•ri• .f.. iw.n N:.N f.lpl a .ii M••i•M M.wM W. wNr M.w w .9 d"s p.riwe Ito. -ops-ow. M -Mck Nr wnwWO ...NK.. k x6d _1* e.. � aw -ft. f w N Od..r...NiINsM • 'fid` `5^ p.1M•••P so r for o" w..iir .t .owstrw r N dwh..d r Maw. •r'/. wGrw .f M.wwtwr: {i) wino ii. w...wew..OPik.ii•• w.ryr be b .30 -r 6' �cz- r a. Nrww.. w.W M r.w.AMe RANow N ilr. DwP•ib.«r. .7 4., +�;�'�'{�y 16. Nome(s) of Lk+nsas(s) 17. Signature(s) of licensees) I& License Number( -P '. n t ,h c 19 LOGali011 -z Nurnber and City and Zip Code ,��,e rDe iVo4� t�llifts�Bewi lives FwPant r t� ,fi�Y�`yn+6�Y Afbchedtw',-[�Reeo►ded naiA�e%' %�13rf Eidudory Potj n }f Q :... _.... .............._COPIES MAILED /� j.4 r roa - �` r ' (] Rettesroh Fee of . id Paat.... ' — Offrce on..... .. Rsceipf No ........i_OC -A80 fit :. 831obwo"t70M5VrCAYw07P NortthNe 1Ate tJM_44W ilOtt IOR:I........n... >11�8t e� +r i� 1• Of U W. •�_ L of Alcoholic Co .. RECEIPT NO.L .. s £� SaaonNtM0. CeM. 95814 off sou Dttwfla{ GEOG ar ..nrereF.aevrr•4ea w � Com- � TM wtdwdyned.tr.rebIF applies for Y not. L c '�GY�. �y1'�.- NRI�nVNfi�RY OJ f<VflVwR -_.-J s=A►�tKANTiSY Te�nR x >F App4W vndw See. 44044 ❑ - _ Effettiw Dotes EAocfiro '`�__ 3. TYPES) OF TRANSACTION(S) �_- - �'' TYPE"� x•. WOW a r w wma The ZMIWt #N" .. 4acotiDtt of B"iness_Number a11d. ' City avid Tip Code Lou# ". 40 County Stns TOTAL S 76.0 1 c< � x n N /remises-censed, 7. Are Premises Inside xme .: 9�Show-Type of license City limits? 140 5 _ Y` -Ma7mp Address`N dilfe+enrfrom a-Nwnbeyrond Smtr,e,�e.t�. fro") 7> —1 �--1i�. �- Dea�vz ilii. �e iLi 4804 9 Hove you ever been convicted of o felony? 10. Have you ever violated any of the provisions of the Alcoholic - �? Beverage Control Act or regulations of tM Department per• .� a 4: coining to the Act? gyp_ f . t s I. Explain o'rYES" answer to nems 9 or 10 on an attachment which shall be deemed port of this applicatiion s; is 1?�J1ppKeont=ogees 4,o that-carmonaper_+mploy@4 in on -sole licensed pre nines va haw oR the queli6eoliens. ii o ee.�snd r ` M will not vk+late or souse a permit to be violated airy of tiie provisions of the Alcoholic Dererege Control Ad. - 13 STATE OF CALIFORNIA County of t `_.-�. �r " tew/r pPr.Mr .f 'P.rlrr. ..t1i Pw.M wMN wie••r.i. .pp.q .w.�. .wrrie.w .wd wwrwt (t) IN k• er..PPNr.r. r w .t ii..hNrwrw, r M ..wt1iK.. ' ' -...fir .1 M .ePlkrrr rq.r.N.w, w.wwd i. do hr+MMe .PMkri.., dwr .*-i-d +. wN►w d" Is « Ns tr.s.e, *),*.I M f,.w .Md'. Ki. i.i.• .:; .,' .. E981.0,.s'ssr•ri•+ w ►».. KN w«Nrw er...t Md' rlrr .«...d .n J " o.% -m. *-.M ,w.e. w 11.y (3) e..r M o. e*r KN. er "Ok.* lMEN ..:, � 7 k - - weeN••"i• t'•• .wr . dMiaw r Miner MMM Mer ."n w o aPvu..ri irrri.wN N M s«AreMJ wwdr ilr. Nrrp.(wl er w.ikA- Mdw "0', N.. k i C (Q II�r.M tirtM y0)kriM M vmo." I iw wr MN N "at .M v-, Or .. 1.« r to MRe M. wY�M~'r MMwI-1wN ur. llrww4rMr (eq. 0 5 f s>•'= d.rw pw.iwe Kr M .rlr)di li. for M Gtwd .riA rtrw D.►riwNww r N ew., r .wNWkA . Pr.hnwrw N r for «► sniw .f re+nwl.r.r r so _i .. dwFwr/ r Mjw. w T .t - A ik.r �ww.t...wtkw:ww �v M .riiidr.w t7 .iKur rir .OP)kwww w d. Ikwr.r .riiA .r. i.wriuirre. iMMN4 w APPLICANT" - SIGN HERE .. ':Itk ..... �. APPLICATION BY TRANSFEROR S. STATE OF CALIFORNIA County of ... ........ . .... Dote _._ , 7 t "Wer Pww.li► .t P- wrr. -A P— -h— nowt—*:.•P.-s ba-. rriiew .M -vu It) )N k M. Nw.wrw, r « ."mCi- .ekr .1 er uiP.r.N M..to Mok.Kww. &4r ev*ed"d N w.- Ws MMdr .POEM M iN twlrMf (:i' MM M & As w"" PP1k dvR N M,$"Ww on, bd~ M rM e".A d New—we) J wrA d Fwd.. .via N ft. -#.r r.r H Kr •.vNw.•r .ww:r Wrri.w MdkoNd « er vPPr pori.. .t Im int ••" rill froidr is .Pyr w.d b M Dir"mr: (3) iho pep." .Mwhw h nH wi.d. N wwoW *• Mr•ri• .f.. iw.n N:.N f.lpl a .ii M••i•M M.wM W. wNr M.w w .9 d"s p.riwe Ito. -ops-ow. M -Mck Nr wnwWO ...NK.. k x6d _1* e.. � aw -ft. f w N Od..r...NiINsM • 'fid` `5^ p.1M•••P so r for o" w..iir .t .owstrw r N dwh..d r Maw. •r'/. wGrw .f M.wwtwr: {i) wino ii. w...wew..OPik.ii•• w.ryr be b .30 -r 6' �cz- r a. Nrww.. w.W M r.w.AMe RANow N ilr. DwP•ib.«r. .7 4., +�;�'�'{�y 16. Nome(s) of Lk+nsas(s) 17. Signature(s) of licensees) I& License Number( -P '. n t ,h c 19 LOGali011 -z Nurnber and City and Zip Code ,��,e rDe iVo4� t�llifts�Bewi lives FwPant r t� ,fi�Y�`yn+6�Y Afbchedtw',-[�Reeo►ded naiA�e%' %�13rf Eidudory Potj n }f Q :... _.... .............._COPIES MAILED /� j.4 r roa - �` r ' (] Rettesroh Fee of . id Paat.... ' — Offrce on..... .. Rsceipf No ........i_OC -A80 fit :. 831obwo"t70M5VrCAYw07P 223 8. OwrokAe Las ` qitryy _�-� pp� Lod193�0 San J is County RECEIPT NO. , TOTAL S 23.00 . 6 M Premises Licensed. 7. Are Premises Inside Show Type of License 20-•269is'9 city Limier? T" 8. ')hailing Address (if different from 5) -Number and Street Rr.vJ t►«w.t , - eve 9 Have you ever been convicted of o felony? 10. Have you ever violated any of the provision of the. AkohoUc Beveroge Control Ad or r"ulation of tM , Deportment pqn no tair"q to tfte Ad? 1fp 11. Explain a "YES" answer to items 9 or 10 on an attachment which shall be deemed part of this application. } _ 13. Appkont ogre" (a), that arty-mormger employed inon•sale licensed premises w will have 08 the qualifications of a- acrd (b) that he will not violate or cause or permit to be violated any of the provisions of the Afcofiofic beverage Control -Act 13. STATE OF CAUFORNLA County of &an.Jo�gnin . - _.'.t _ ..-._-... DO,, �1�.31_.-_�_ -�. _ ----� Y­ d Ir.. i. Ny ti .. tI.M. M�.tl► r.i rr.s lit !N r . w of M:. .v►)iwwN. w w ...,fir.. �Mr ,te^r.r. .Vi. M,::� .w M(rr. .Airr er ,�, _ mm"Illit',pinm 0,11m- aRW .f d. •P'dic r• ear..r n.m, .good am d.- f«•e•i•e .V.ikgt; w Arlt .adrri"a h M e dna wrlie�al•• aana itshomi M thea M •epxaarl.m a.rd r.rn.e ant e..gma 0-4- -4 rAar -ch-4 an .f d. e"" -ft d.wi. med. ate. rro.r- (h) MM a Mww aaMe i 1 w. ant ..ells.xM + MV==M- ALCM)= UVMAGK WCENISE(S) 1. TYPE(S) OF UCENSE(S) FILE NO.:,: ./..anal o.rm.- fN. d-ra fr•r• a nra "r .r6Id ar..amef" a,Ni.w h e(.d r4. D.7.,W m . at. ft P -i 5 i kl. Tor Depark"" of Akohofic beverage Control FEE NO. a .1215 O Steeet _:_ . .. y_ Souon�enw. CoN 9581! Stockton . .ersrner wcww wewno«r - Ott sale 8N!`A Vias CEOGRAPHKAI CODE �✓ai t — ............ ..... __ .... ._. - .. . . ... --------------------- 3902 .' k. The untbr igned bnby applies for ? ` Dote ` 15: STATE OF CALIFORNIA County of.:_.. _ l[t[_d.Q1RQ1i A.. ............... ...... Ikvmer dirrnbed es followu i', ? �,a�% isswed c . ,p 2. [,{AWES} OF APIUCAWM MIaad Ya Ilr.f./.II..Na,d.r..M.dMdasm.M 14 M. Jm p.ToadawandM/N ha1.baehNwMh Tw(rd►Gaad/1Md MM e.u. ItM pr rraMsyik.d.. wea aN,krfadtM.e b amfi M 0. Watk.4 d%W in.md N Or—A. M N the VOtaN fem1. it onit fr.wal.I L .Mrawd it de DYsarj (s1 thatda eroM/N:apyekaN.a erawafN is M arai► M eaaleir ant lana N;w !ante 4 r p.►s,.1 prw.M .1 e: _; .. Applied under She. 310{1 ❑ ' POO Effective Dutch When Trfd. Effective Dot. >r 3. TYPES) OF TRANSACTIONS) FEf TYPE= Signotyre(s) of Licensee(:) _ 18 Lkettse 1d Nome(s) Of Lksrsee(s) 17. n t E.. SPUAVin 20-261.69 xr: L f Fm To mm- 25.00 r y., and Ti 19: Lbcatjm $- Clf!1('q)tur L 9S21t0 Sart Joap Sn P Code CouMr t A. Name.of businm 4 - ` :.. ♦-, stsurglats '. l5 f c : 5, Location of Business -Number and Stme • 0.19dudfxypopers. COPIES MAILED.. ..... r t \ r Mtnewoh Fee of ............ ...Fold °t:�... '`�---------------- - - --------- Office on..... .. --' ........Receipt No - - ..,kk 223 8. OwrokAe Las ` qitryy _�-� pp� Lod193�0 San J is County RECEIPT NO. , TOTAL S 23.00 . 6 M Premises Licensed. 7. Are Premises Inside Show Type of License 20-•269is'9 city Limier? T" 8. ')hailing Address (if different from 5) -Number and Street Rr.vJ t►«w.t , - eve 9 Have you ever been convicted of o felony? 10. Have you ever violated any of the provision of the. AkohoUc Beveroge Control Ad or r"ulation of tM , Deportment pqn no tair"q to tfte Ad? 1fp 11. Explain a "YES" answer to items 9 or 10 on an attachment which shall be deemed part of this application. } _ 13. Appkont ogre" (a), that arty-mormger employed inon•sale licensed premises w will have 08 the qualifications of a- acrd (b) that he will not violate or cause or permit to be violated any of the provisions of the Afcofiofic beverage Control -Act 13. STATE OF CAUFORNLA County of &an.Jo�gnin . - _.'.t _ ..-._-... DO,, �1�.31_.-_�_ -�. _ ----� 3.faa� d Ir.. i. Ny ti .. tI.M. M�.tl► r.i rr.s lit !N r . w of M:. .v►)iwwN. w w ...,fir.. �Mr ,te^r.r. .Vi. M,::� .w M(rr. .Airr er ,�, _ n aRW .f d. •P'dic r• ear..r n.m, .good am d.- f«•e•i•e .V.ikgt; w Arlt .adrri"a h M e dna wrlie�al•• aana itshomi M thea M •epxaarl.m a.rd r.rn.e ant e..gma 0-4- -4 rAar -ch-4 an .f d. e"" -ft d.wi. med. ate. rro.r- (h) MM a Mww aaMe i 1 w. ant ..ells.xM + ;f • '- ` e•iM at .Ner.ra has ..r dire,a N iwdkftq irae.r-0 is ,M aprrr w e N PON. 6 b";- » M awJ.aN1 Ywdar. Ike . t:rwrt6) M %411A AN "Ot.- IN dm► em-*••ef r mpvumlk. N ,rawalr k ver m.d.-a. a.tkfV We of . I.aw s N raise a..et..mewf a.kr.d iwM Mn•dar .tweatr tt+el `. . ./..anal o.rm.- fN. d-ra fr•r• a nra "r .r6Id ar..amef" a,Ni.w h e(.d r4. D.7.,W m . at. ft P -i 5 i M a10 ..int N M e.'..r wraWkA P.ta.V H...f ..0. i.irard r h+— •m, er.dia.r .f traraaba.r: (S) dr.r the a.a .0. epVr,. — M. M rWml ..a It, aid- air aa/Ik.wa r air. U.-. t r41Y wa .A11•0 H bmrr f. da 0.wa11rM., a 14. APPLICANT SIGNHERE _ ...._ _ - ... _---- ---- ------....... �✓ai t — ............ ..... __ .... ._. - .. . . ... --------------------- ' - APPLICATION BY TRANSFEROR ` :& o- 15: STATE OF CALIFORNIA County of.:_.. _ l[t[_d.Q1RQ1i A.. ............... ...... ? �,a�% {I.der � ad prFPr..a.► /.raw .riven •le•r•r•� arp.wn W_.,Mie.e mod nava. (t) !le 4 d. I.rm.e, N a» w.arN...Rw .f de arPra/. il,a,wr c . ,p f MIaad Ya Ilr.f./.II..Na,d.r..M.dMdasm.M 14 M. Jm p.ToadawandM/N ha1.baehNwMh Tw(rd►Gaad/1Md MM e.u. ItM pr rraMsyik.d.. wea aN,krfadtM.e b amfi M 0. Watk.4 d%W in.md N Or—A. M N the VOtaN V fem1. it onit fr.wal.I L .Mrawd it de DYsarj (s1 thatda eroM/N:apyekaN.a erawafN is M arai► M eaaleir ant lana N;w !ante 4 r p.►s,.1 prw.M .1 e: - r aerwmmd .raved nth ave. dw Wan, d." rram 0 da d.r a. _Ak% era a,.m, W.. Pon., Is cid .,Id +k. Derarlm.tot N M falai .-mb"A e " �mlrwa is N far .•r era 11- .1 M.aal.-- N w. defraud ar i.ler. amV o.di,r .1 fr.w.hr.q (A dN ala trmolr anaxe.rW mq M ,a.sAAa.a,..IH atdrer" !lata ee/ll.ard w do n.eraa.a _kb .. waWO6,q li.Wft N elm Der.rawwf. 1: Signotyre(s) of Licensee(:) _ 18 Lkettse 1d Nome(s) Of Lksrsee(s) 17. n t E.. SPUAVin 20-261.69 xr: L f r y., and Ti 19: Lbcatjm $- Clf!1('q)tur L 9S21t0 Sart Joap Sn P Code CouMr t ` Do Not Wilk l3, W This Ltnef;)For Departmerd 6.s '. l5 f Altachedtl �lLr:Recorded naticw 0.19dudfxypopers. COPIES MAILED.. ..... r t \ r Mtnewoh Fee of ............ ...Fold °t:�... '`�---------------- - - --------- Office on..... .. --' ........Receipt No - - ..,kk ADC 21 ,..,„ O rT 2 0 OPT _ ....-_ +.,<c+;,.a�vkcorork:,:.crani>xvaaanw,.+'•.'. 4 traay...