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11. FATHER'S NAME: �heah AoLoyw,? 12. MOTHER'S MAIDEN NAME: f�s rig S; b� <br /> 13. IDENTIFY YOUR CRIMINAL RECORD, (Massachusetts, Military, any other State or Federal):ANY OTHER <br /> ARREST OR APPEARANCE IN CRIMINAL COURT CHARGED WITH A CRIMINAL OFFENSE <br /> REGARDLESS OF FINAL DISPOSITION: <br /> YES X NO (MUST CHECK EITHER YES OR NO) <br /> IF YES, PLEASE DESCRIBE OFFENSE (S) SPECIFIC CHARGE AND DISPOSiTICN (FINE, <br /> PENALTY, ETC.) <br /> 14. PRIOR EXPERIENCE IN THE LIQUOR INDUSTRY: K YES NO <br /> IF YES, PLEASE DESCRIBE: <br /> e:Al- c ut i4%moo/ L%gvois in ii�aani£ rJA' <br /> 15. FINANCIAL INTEREST, DIRECTOR INDIRECT, IN THIS OR ANY OTHER LIQUOR LICENSE, PERMIT <br /> OR CERTIFICATE: k YES NO <br /> IF YES, PLEASE DESCRIBE: 'Pr;'n Ci Aa a,/*0 ni., Z„ c <br /> 16. EMPLOYMENT FOR THE LAST TEN YEARS (Dates, Position, Employer, Address and if known, <br /> Telephone Numbers): <br /> Ou�nei` o,�' t� .[�a�h since /996 <br /> 17. HOURS PER WEEK TO BE SPENT ON THE LICENSED PREMISES: IZ Aavrs 0f/T�_ <br /> 18. 1 HEREBY SWEAR THAT UNDER THE PAINS AND PENALTIES OF PERJURY THAT THE <br /> INFORMATION I HAVE GIVEN IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE <br /> AND BELIEF. r' <br /> BY: i�LYI—L <br /> PROPOSED MANAGER SIGNATURE DATE <br /> F9FiLESMAUREE.N,i WAU REEMFO Rh15'.FCRAU.'NP7 <br /> 9/99 . <br /> 2 <br />