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1 , <br />550-CO-APPLICATION FOR BEER LICENSE-County BURNIZII <br />APPLICATION FOR BEER LICENSE <br />To the Hon. Board of County Commissioners of 1.-QS.S <br />County, North Dakota: <br />The undersigned applicant hereby makes application for license to engage in the retail sale of beer off of (and on) <br />the premises hereinafter described, and as a basis therefor makes the following representations: <br />1. Name of applicant 1.21.$...CMe-V%sS4-) Cp0lc <br />r <br />Age 51- years. <br />Citizenship U.S Place of residence----... .E 1.0,-ND <br />For how long past have you been a resident of the State of North Dakota?8.. / eac-5 <br />2. State whether i orp ated...- -5 If so, in what State incorporated? NA <br />Date of charter 9 1 0 a.QL- Name and address of each officer: <br />DC,regof1 P.. Cc oK 1133 S 1 041, Si- FarS9 , Nb 58i 0 3 <br />Lisc. CooK A <br />3. State whether partnership ye.-S If so, state name, age, citizenship and place of residence of each <br />partner G(9c' x e. Coo K, 588 Y eaS f rArlO N ti V S CI 4.i 2Cr'1 <br />Llsc Cook 5- - I <br />years 1 <br />1% i. <br />4. In what businessrr / are youenow engaged?+N Dm Dome S i /4.-/ ( . net' <br />Business address..3. -U(/ 15624K Ave.,+ se-- f .lc+o /1----!y v S8GS c1P <br />Description of premises for which license is <br />desiredtip d vie/,: or of building <br />located on lot in block in SU lit4- AA'iocs-6= - I- See 101 '.Addifion to said <br />Cite 51 <br />6. Have you pleaded guilty to or been convicted of a crime? N0 If so, what crime? W. ft <br />In what Court? .N 'When? NA" <br />7. Will you personally conduct the business on premises hereinbefore described and for which license is ap- <br />plied?.. L.5 If not, state name, age, citizenship and place of residence of person who will be in charge thereof <br />N ' <br />8. Have you received a license to engage in the retail sale of beer at said premises from the Federal Government? <br />When issued? ekft Number of license Nr' <br />9. Have you received a license to engage in the retail sale of beer off of (and on) said premises from State of <br />North Dakota?-..GS When issued? oW <br />t")? <br />Number of license.C.hd q yearly <br />10. Do you promise and agree not to permit the violation of any law of the State of North Dakota on said <br />premises? ye-s <br />11. Do you promise and agree to abide by the rules and regulations passed by the Board of County Com- <br />missioners? la.5 <br />12. Do you promise and agree not to sell or permit the sale of beer on said premises to a minor, incompetent <br />person, or a person ard, or to any one thereof? las <br />13. Do you ukfr=itr . upon this application will not be transferable except by <br />specific authority ofd aid goverMOpkb will auto .rize the retail sale of beer as herein applied for only at the <br />place and on the pr. .-* • '..:..14i. a.•licati and in such license? •1 LS <br />The applicant herein does hereby consent that the Chairman of the Board of County Commissioners, the Sheriff <br />and any police officer of the County of C5.5 aforesaid, or any person or persons duly <br />authorized by the Board of County Commissioners of said county may enter upon the premises described <br />in this application at any hour of the day or night, and that they and any one of them shall have free access to the <br />said described premises and every part thereof for the purpose of inspecting the said premises and the records of this <br />applicant relating to the purchase and sale of beer, and applicant does hereby waive any and all rights that he may <br />have under the Constitution of the United States and the Constitution of the State of North Dakota relative to <br />searches and seizures without issuance or use of a search warrant, and the applicant does hereby agree that such <br />immunities shall never be claimed by him, and that such search, seizure, and inspection may be made at any time <br />without a search warrant. Do you agree to each provision of this paragraph? ve.s <br />The amount of the remittance accompanying this application is $...2.50.:..0 0 <br />Dated at 00410 North Dakota, on this c2..2 dayday <br />of '(\Pitch 20..a.gf <br />C;;;i6C-- COI+) <br />Applicant.