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. ����IVEC� � <br /> JAN Q � 2006 APPLICATION F�R LICENSE TO <br /> TY OF ORONO 0 SELL TOBACCO PRODUCTS AND <br /> O� �Q TOBACCO RELATED D�VICES , <br /> (Ordinance No.164,Second Series-Adopted 12f08197) � �� <br /> r�a �, D* ��.� �i' <br /> '�'.c, �ti`� Make check payable to: City of Orono �� ' <br /> �`��.�sHo�`'� <br /> Mailing address: P.O. Box 66 <br /> Crystal Bay, MN 55323 <br /> FEE: $100.00 (February 1-January 31) _ ��— �'—� � <br /> DATE <br /> 1. Ap IicanYs Ful( Name <br /> � ` � i� <br /> FIRST MIDDLE LAST <br /> 2. Applicant's Home Address <br /> � � �� ,�� �- � ���.� �-���-� y� <br /> HO SE NUMBER STREET HOME PHONE <br /> �/�t� v�9 c�. w1 V�' � �5� �� <br /> CITY STATE ZIP <br /> 3. App(icant's Business <br /> S�� 1�1�L C ��T�7—I D h� �r�--- �f�1� �(�� �' <br /> TY�E OF BUSINESS BUSINESS PHONE <br /> ✓l ,�G/,��'2.�-- C�. ��� ? ���� �fi`Ud�� � � � <br /> B�'J INESS NA E STREETADDRESS <br /> ��� �� �1r�4r/r�-2/� s '3��-- <br /> MAILING ADDRESS CITY ZIP <br /> 4. Describe how the actual physical exchange of the tobacco, tobacco product, or <br /> . tobacco related device between the customer and the licensee or employee takes <br /> p(ace. �Lf�� �—rrc�r�t/��/� . <br /> l HEREBY MAKE APPLICATION FOR LICENSE TO SELL TOBACCO, TOBqCCO <br /> PRODUCTS, OR TOBACCO RELATED DEVICES AT THEABOVE LOCATION SUBJECT <br /> TO THE LAWS OF THE STATE OF MINNESOTA AND THE ORDINANCES OF THE ClTY <br /> OF OR NO. � <br /> � ,. �. y.—r� <br /> Si ature Date <br /> The issuance o/a license under this ordinance shall be considered a privilege and not an abso/ute right of the applicant❑ <br /> and shall not entitle the holder to an automatic renewal of the license. <br /> For Office Use Only: <br /> Reviewed by: Recon ends: <br /> C�Approva] ❑ Denial <br /> ... . . ... <br /> ��cn v,n�..n.,.t..,,.,., n n n,,.• �� �.-.,�+�t A�., r,rt.t c�i�z <br />