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• <br /> Vice President LaVcz fila(`e 5 v4tL_ <br /> 11110 <br /> Residence Address i� Ze,w yAni ink S�. A/£ Phone 33/ <br /> //7f,/s.1n,�✓ ✓✓s5 -//5' <br /> Secretary <br /> Residence Address Phone <br /> Treasurer <br /> Residence Address Phone <br /> (A Part II - Personal Information Form must be filled out and attached for these individuals.) <br /> The full names, residence address and telephone number of all persons who singly or <br /> together with their spouse and his or her parents, brothers, sisters, or children, own or <br /> control an interest in said corporation or association in excess of 5%. <br /> 1. Full Name /3A1•44 CA Am/5.Al 7—v het k /;7/7 Interest <br /> Residence Address ... 5 / -5-.7`bvs-a-1 1/Vat Phone 7eF"-q <br /> 1110 2. Full Name Interest %o <br /> Residence Address Phone <br /> 3. Full Name Interest <br /> Residence Address Phone <br /> 4. Full Name - Interest % <br /> Residence Address Phone <br /> (A Part II - Personal Information Form may be required for these individuals.) <br /> 0. The full name, residence address and telephone number of the manager, proprietor or other <br /> agent in charge of the corporation's or association's premises to be licensed. <br /> Full Name JONA l.a► 1renect Yhocce cjc( Lapfsel I cc 5„ =Ak <br /> Residence Address aaY &'t1 amp , Phone let - 3 3122 <br /> /hfls. , M,✓ Ssy/S <br /> (A Part II - Personal Information Form must be filled out and attached for this individual.) <br /> 4 <br />