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DEPARYMENT OF LIQUOR COWROL COUNTY OF HAWAVI <br />r0a lagoon Cenfire J O f A�! ipwnjSf, UrW 230 H46. HnwVPiQ612(J i F'h0t)Q: 1,908)916V8y.f49 *-Fax- [&M1961.36,54 <br />PERSONAL HISTORY ANO AFIFIDAVIT <br />(TYPO or Print AN InformaNan) <br />NAME <br />I. INFORMATION AS RMT11KED WfTH THE DEPAVMENT Of COMMINCE AND CONSUMER AFFA4K- <br />Lisl re<,) bUdneb ,"Ome ang 11aa, <br />C.Lment 04fical 11me, you had wlr� + ("giate-red 15URnms lcwf Lit 7TIK &A <br />_r?'_ Ct Vim. <br />It Gplaic:c]43,49 ir-o. percerto,,je -if Vockil�hclrrp_ j V"Iu 'Mold r2 <br />11- UST rAsrowNrismPoF LIQUOR LICENSP- <br />ugg"WANAW "A YEAR <br />411. EMPLOYMM RECOW. i a -vex hiSpop ,n5f e6C*mp, o y <br />01,p, P"rjj trr'e.q <br />ENV TQ PO4moy NAW 0F!QQ dfANY CITY/W <br />I <br />101 --*- � ti <br />.. _ ....._ y o'" It, kit <br />R E Cm E rV ED <br />ff addizonatwiva is �, we ramirse sidle. <br />UV. COMNAt RECORD, IF ANY: Chock box, SEP /26 2G25 ljw <br />have not been c0.,nV10ed of any tekriy Dept. of Liquor Control <br />HILO <br />I I have beim convtcted cj 43 tejpry c,"arce!3,4 It Me on-mioviar i; irl *1-,e W fisr"a live plat pis <br />00ir"19 first duty Wvm;yn, deposes or.,. -I %tjyj rnq�or <br />at4ri is ifue and cwevi <br />Ai�W6F ftw* 0*4b 14.d 7119wary <br />Subscr�bed anti yworn t�z� b<aekytt: me <br />-w- <br />a v of A j Zen <br />DA J44 164111644k <br />"taN PLblfc Isignarwro-) <br />Aj K hP6. <br />Out- <br />Nolary Pubic 1pfini norr.01 <br />STATE OF tVX%�51" <br />MV Comftss'arf «rNe <br />a ��06946'46 <br />Revimid. Ug,*"T? <br />4 Pagel j <br />Af-MV-1- ��v_QDKA <br />vvipl vi PqmQrDLtd1QEV 5 tw ment <br />I- I A U6 9 zt�� <br />n_at_Lre- - _Ejale <br />I OpMrtutlay Pmymer and Emplayw <br />EXHIBIT 3 <br />