get Et QC C. AFTER SO (31111-rf NIG REPORT

get Et QC C. AFTER SO (31111-rf NIG REPORT CARO', f\NErt Mt SURNAME • wo--_-; t.71- e -Nov-leaps swum Government of South Australia Office of the Liquor and Gambling W' s'. Commissioner ri ck6CZOENTED v•JfklYieN )N1 AL/- Re. pog-rs Order Barring Pen From a Licensed Premi: Office of the Liquor and Gambling Commis Level 9. Eost Wing, 50 Grentell Street Adefoide S. GPO Box 2169 Adetilde S. f • w www.c4gc.sa.gov.ou or vnvw.chorfties.so.£ For assistance with this application, refer to 'Burring a Person from a Licensed Premises - Information she( Order barring person from entering or remaining on licensed premises Name of person to be barred Address (if known) Zack; c (Z'oc ctc.) e Ine *Gray No: street: vv suburb/Town: postcode: Under Section 125 of The liquor Licensing Act, you are barred from the following licensed premises Premises name Licence number Address of premises rCerrl-- 11 0 -1- f..-1 5 O 1 0 0 4 S No: 3 0 street: A l ey an d er 5+ suburb/Tow