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014
12/18/00 MON 19:14 FAX 202 616 6069
OPA/DOJ
DEC-4-2000 04:16P FROM:NORTH AMERICAN GOLD 7027357318
TO: 12022247327
P:4/7
MARNIAGE STATUS
Single
Manied
Divorced
Widowed
BRANCH OF SERVICE:
Date(s)
Type of Discharge:
none
dnd
dna
FEREINCES: List Three Who Have Known You Years
Name: (Last, First. Middle)
Business Phone
I.
Huggins, Max, Sr.
retired
Address: (No, Street, City, State, Zip Code)
Vernonia. Oregon
503-429-0140
Name: (Last First. Middle)
Business Phone
2.
Goldberg, Julie
702-229-3578
Address: (No., Street, City, State, Zip Code)
400 East Stewart Ave. Las Vegms, Nevada 89101
Name: (Last, First, Mickle)
Business Phone
Dutton, Jean
retired Clark
ddress: (No. Street, City, State Zip Code)
County Assoccor
Laguna, Califronia
714-497-8107
LIST THE PLACE YOU HAVE RESIDED DURING THE LAST TEN (to) YEARS
Number and Street
&
State
I have lived at my present address for the past 16 years.
LIST YOUR EMPLOYMENT DURIN THE LAST TEN (10) YEARS
N DIE 0: Employer
Business Address
City
State
Full or Pan
Time
I have owned and operated the Tower of Jewels in Las Vegas for the
HEREBY CERTIFY that this is a fun
last 30 years
true nd correct copy of the original
Questi onnaire
on file with the Les Veges Metropolitan
Polla Department.
annette Ceparane
ORDS SUPERVISOR
S. outs this Permit be granted, L the Applicant herein accept it subject to a faithful compliance with the provisions of the applicable
statute, nuinances. rules and regulations supertaining to the carrying of previously described concealed weapon, and subject to the
buth DI the apresentations herein made and the full disclosure of the information herein asked. Additionally, I solemnly attirm that the
ret reselvations herein made and the information here given for pages 1. 2 and 3 as an Applicant for a Permit to Carry 3 Concealad
Wedpen are true and complete to the best of my ability. knowledge and belief
SUBSCRIBED AND SWORN
10 uulo, THE uus
15
day
SIGNED. wemate
01 ELEUARY 1994
Applicant 2-14-94 for the Within-Descuped Permit
NOTARY PUBLIC Custer
DATED:
5-83) PAGE 3 OF 4
Page data
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- Type
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Document data
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- Core
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- Type
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"ocrText": "014\n12/18/00 MON 19:14 FAX 202 616 6069\nOPA/DOJ\nDEC-4-2000 04:16P FROM:NORTH AMERICAN GOLD 7027357318\nTO: 12022247327\nP:4/7\nMARNIAGE STATUS\nSingle\nManied\nDivorced\nWidowed\nBRANCH OF SERVICE:\nDate(s)\nType of Discharge:\nnone\ndnd\ndna\nFEREINCES: List Three Who Have Known You Years\nName: (Last, First. Middle)\nBusiness Phone\nI.\nHuggins, Max, Sr.\nretired\nAddress: (No, Street, City, State, Zip Code)\nVernonia. Oregon\n503-429-0140\nName: (Last First. Middle)\nBusiness Phone\n2.\nGoldberg, Julie\n702-229-3578\nAddress: (No., Street, City, State, Zip Code)\n400 East Stewart Ave. Las Vegms, Nevada 89101\nName: (Last, First, Mickle)\nBusiness Phone\nDutton, Jean\nretired Clark\nddress: (No. Street, City, State Zip Code)\nCounty Assoccor\nLaguna, Califronia\n714-497-8107\nLIST THE PLACE YOU HAVE RESIDED DURING THE LAST TEN (to) YEARS\nNumber and Street\n&\nState\nI have lived at my present address for the past 16 years.\nLIST YOUR EMPLOYMENT DURIN THE LAST TEN (10) YEARS\nN DIE 0: Employer\nBusiness Address\nCity\nState\nFull or Pan\nTime\nI have owned and operated the Tower of Jewels in Las Vegas for the\nHEREBY CERTIFY that this is a fun\nlast 30 years\ntrue nd correct copy of the original\nQuesti onnaire\non file with the Les Veges Metropolitan\nPolla Department.\nannette Ceparane\nORDS SUPERVISOR\nS. outs this Permit be granted, L the Applicant herein accept it subject to a faithful compliance with the provisions of the applicable\nstatute, nuinances. rules and regulations supertaining to the carrying of previously described concealed weapon, and subject to the\nbuth DI the apresentations herein made and the full disclosure of the information herein asked. Additionally, I solemnly attirm that the\nret reselvations herein made and the information here given for pages 1. 2 and 3 as an Applicant for a Permit to Carry 3 Concealad\nWedpen are true and complete to the best of my ability. knowledge and belief\nSUBSCRIBED AND SWORN\n10 uulo, THE uus\n15\nday\nSIGNED. wemate\n01 ELEUARY 1994\nApplicant 2-14-94 for the Within-Descuped Permit\nNOTARY PUBLIC Custer\nDATED:\n5-83) PAGE 3 OF 4"
}