THE CORPORATION ‘OF THE CITY OF PORT COQUITLAM
APPLICATION FOR BUSINESS LICENCE ©

Name of Applicant ...0........L0EEE PREC OPOUT OR

Home Address of Applicont .............#111/e¢s2 heallister

Name and Address of President of Incorporated Company ..

. . Theos Lnterrrises Ltd.
Trade Name of Business (if amy) . 200... cece ee ceee cceeeeee cee oo eta eteceateccesd es eeeneeoeecaeresaerecetaeas seesesesaenaazennens

Fort Coquitlam, 3.C.

Business Address
Telephone Numbers: Residence bd bolo

Licence applied for Cabaret

Nurmber of Persons engoged in business

Have You held a Licence Before? NES __.... If 50, state when

Where: .....-..------ Fort Cosuitiam

Has applicant ever been convicted of any offence of a criminal nature, or had a previous licence cancelled

or refused: Yes No... Particulars (if any)

ADDITIONAL INFORMATION TO BE SUPPLIED FOR THE UNDERNOTED LICENCES

Apartments, Hotels & Auto Courts: No. of Rooms available for rent

Barbers & Beauty Parlours: No. of Chairs No. of Operators

Pool Rooms & Bowling Alleys: No. of Tables No. of Alleys

Vending Machines: 1c. only machines Other Machines ....

1/We hereby make application for a licence in occordance with the particulars as above stated and
declare that the above statement is true and correct, and ! understarid that if | am granted the licence applied °
for, | must comply with each and every obligation contained in all Laws and By-Laws now in force, or which
hereafter come into force in the City.

. j 1 4 :
a Bl, 192Z. Signature of Applicant Ri Lote cepa tee
IT IS AN OFFENCE TO MAKE A FALSE DECLARATION. i

CLASSIFICATION:

Approved: .... an
inspector (at date of establishing business)

Date sf Ras le a , 192. Fee: $2 Zee

for period ending ..., ran |