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FORM A CHANGE 0F.ffi MANAGER <br /> i <br /> 'THIS FORM IS— COMPLETED WREN. H- F' S- CHANGE IN THE MANAGER OF A <br /> CORPORATIOMe <br /> INSERT THE NAME `OF THE LICENSEE ON LINE S,ELOW. <br /> (TELEPHONE HUMBER <br /> DAME OF NEW MANAGER: � �.• <br /> H014E ADDRESS : I cto Lu Yh4440 L/Vy 1,00L4 73 <br /> PLACE 'OF BIRTH: . bu()Y-CLIf cr4l� <br /> � <br /> DATE OF -BIRTHS ' _ . .- <br /> - REGISTERED <br /> . . . <br /> `ARE YOU A CITIZEN.: YES ' NO <br /> COURT -AND, DATE -OF NATURALIZATION: LA TS 1%S <br /> FATHERNAME: �� MOTHER'S MAIDEN NAME: <br /> POLICE-- RECORD:., _ : _--. L T F'E D ,.ARRESTS- <br /> -PRIOR EXPERIENCE IN THE ' I„ INDUSTRY: <br /> g:A,,:5r. 14 oc4w4 icig 7 CjgcE.4 oo�P1 L <br /> TO ujV1 OF* 6H o4t rHA644 1v cLu CAJ6Okv <br /> FINANCIAL INTEREST F DIRECT OR INCIRET, IN ANY OTHER LIQUOR LICENSE <br /> :. 1 Ao <br /> EMPLOYMENT FOR THE LAS'S 'SEN YEARS : (Dates , Position, Employerp <br /> pt t T/Lo ko S r ks AOS 4- htuAxts <br /> PruA pv-rc1LAor4 r r bov 4 1�- I Aj <br /> k0J FAf-I Coo 1A.1C. domp <br /> 8/88 SEE OVER <br />