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r r <br />Ajham, IC44WIN0,_ <br />STATE OF _A+6^ <br />My car' mr4ss=an <br />Revised. OW"I 7 , awai <br />DEPARTMENT OF LIQUOR CONTROL COU`I N OF HAWAVI <br />Hgo Lagoon Cen rre Q 1 A► pun, S r . Unift 2-30 H00, Ha f 'r 06/2a * Phorligo: * F0,%_ (806)961.4664 <br />� w <br />PERSONAL HISTORY AND AFFIDAVIT <br />(TYPe or Pdn# M Informaflanj <br />NAMIE _ . <br />L INFOMIi 110N AS RMUTERJED WTH THE DEPARTMENT OF COMWItU AND CONSUMER A"Alft, <br />List r �vted bu0neis nab cmck,-j1,IV—!1_44-39 <br />�ti 1)6 � 1#c6uret alfic.efi#ll u h wi s . t �fe t ,sin . �"�� _ Effect'-ve Dose <br />t�;a�ck3!jhCwes Vau+aid« _ <br />IL UST PAS OWNERSMP OF UQUOR WCENSEt <br />U&ftnf N <br />M. WFILOYMINT RECO <br />6 12 NA1 E QF_C II}A1My CITY�A:1'E <br />of tt aw I&EMimr4_1O_ a tXw, tit <br />WECE i VED <br />W. CINMINAL RECORD. IF AIVY: Check, Wx. <br />CEP 2 6 202%* <br />Pit i hOwe t1ot been e0nw#0ed of anY felDf+Y cHQtgeM'sj <br />Crept. of Liquor Control <br />i i I ham bey cansted c# a reiprq chaae Is it i)e o'' wer a in -he CdNma hire please 11%1 H I LO <br />0eng Gill duty sw , a gazes =4 saes tip <br />Subscnbea anci ravom to beto a me <br />Ins M1�dav of �i�rT ?jr 1-15 <br />r, rotary Public ! manoturt l _ <br />49 . <br />041 <br />+_+04P <br />is Ifs and carrert <br />4A <br />SignShWO of APP11cmiffbMwe Natary <br />2aw N fib' s 1 <br />mto <br />US 2 <br />riate <br />OPPORUIVy Mgw,,ser and EnVj0VLy <br />EXHIBIT 3 <br />