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3. Complete the following requested information for each individual, partner or officer of <br /> corporation(use additional sheets as necessary): <br /> Full Legal Name <br /> Date of Birth <br /> Alias Names <br /> Social Security Number <br /> Driver's License Number <br /> HomeAddress <br /> Telephone—Home - Work- <br /> Address at which applicant has lived during the past five years <br /> Business Title <br /> `-' Percentage of Interest in Business <br /> U.S. Citizen Yes Naturalized Yes If Yes, give date and place <br /> No No <br /> Have you ever been convicted of any felony, misdemeanor or violation of any ordinance <br /> other than traffic? <br /> Yes If yes, give time,place, offense and penalty: <br /> No <br /> Occupations and State where worked for the past five (5) years: <br /> Occupation City/State <br />