FORMN
0-18
LICENSE NO.
OUTA
FOUCE
APPLICATION FOR DRAMSHOP LICENSE
TROPOL
METROPOLITAN POLICE DEPARTMENT
KANSAS
Office of BOARD OF POLICE COMMISSIONERS
CITY MO
To the City Auditor and the Police Commissioners of Kansas City, Missouri
STATE OF MISSOURI
COUNTY OF
s.
191.-
ACKSON
The undersigned..
being duly sworn, upon oath states that he now resides and for
years last past has resided in Kansas
City, Missouri, and has paid taxes therein for the past year, and hereby makes application for a license to keep a
dramshop (commonly called a saloon) at No.
1n
Kansas City, Missouri, and states that he is a person of good moral eharaeter, and that he is not disqualified under
any law of this state to receive a license to keep a dramshop; that he is not the agent or representative of, nor
not the agent or representative of any brewery or
partner with, any person so disqualified; that he i
any person or corporation engaged in the manufacture or sale of intoxicating liquors, and that he, the said
is the sole owner of the said dramshop at
for which this application for license is made;
No.
and that such license is applied for and, if used, will be held and used for the sole use and benefit of this applicant.
Applicant further states that the building numbered
in which such dramshop is to be located is a.....story building, and that the part of said building not to be
used for said dramshop is oceupied as follows:
(State for what purpose or business.)
and that the said building has the following entrances:
Affiant further states that said building,
any room or portion thereof, is not used for a bawdy house,
assignation house, nor for any other immoral or unlawful purpose, and that said room in which said dramshop
place used
rother means of communication with any room
not connected by any entrance, exit
located
as a bawdy house, assignation house, or for any other immoral or unlawful purpose.
day of
191
Subseribed and sworn
before me this.
Notary Public for Jackson County, Missouri.
191
My commission expires
