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� � <br /> APPLICATION FOR LICENSE TO <br /> /,�p�, SELL TOBACCO PRODUCTS AND <br /> p p TOBACCO RELATED DEVICES � � <br /> (Ordinance No.164,Second Serles-Adopted 12l08/97) ✓q � ����'� <br /> 6 �I N <br /> `��, �ti�' Make check payabie to: City of Orono�, ����� CITyO � �z406 <br /> v F� <br /> L`�kEsxo�"� Mailing address: P.O. Box 66 � R�NO <br /> Crystal Bay, MN 55323 <br /> FEE: $100.00 (February 1-January 31) `� � �� <br /> DATE <br /> 1. A �ant's Full Name - <br /> PP_ •� , <br /> ` K�V� �y ����� p� � <br /> FIRST MIDDLE LAST <br /> 2. Applicant's Home Address � ���� �� ��l �� <br /> '�:'� ���������''��, � � � ���� <br /> j,HOUSE NUMBER STREE•T HOME PHONE <br /> �: ^ '�,', <br /> � ` �,�,t'� � 'v'`�'� �S�`3 <br /> CITY ATE Z�P <br /> 3. Applicant's Business , ��1 <br /> �r- � °� ��,�i`?��'^C' ���� —C Z��'����_�%', <br /> `C�_�`�.� <br /> TYPE OF BUSINESS BUSINESS PHONE <br /> � - � a 1 <br /> �'q�� "��:`c �. ��q�,Q'� �..,��+._,,, ��e'°l.'1 ��.a'�4.,�����, y ",�'�.' <br /> BJSINESS NAME STREET ADDRE S <br /> �,.a-� .��.-�; �i ��,���;� � �.�,-����. <br /> MAILING A�DRESS CITY ZIP <br /> 4. Q�s�ribe how #he actua{ physical exchange of the tobacco, tobacco product, or <br /> tobacco related device between the customer and th licensee or employee takes <br /> ��lace. ��a'� �:�� �:,` � " ' ' <br /> `` ^ €� ;\y�:'`� x- { `�p �'a r <br /> R� y' <br /> ! HEREBY MAKE APPLICATION FOR LlCENSE TO SELL TOBACCO, TOBACCO <br /> PRODUCTS, OR TOBACCO RELATED DEVICES AT THEABOVE LOCATION SUBJECT <br /> TO THE LAWS OF THE STATE OF MlNNESOTA AND THE ORDINANCES OF THE C1TY <br /> OF ORO C� r�` <br /> . _ ..,1 <br /> ���� � � � �,S <br /> n\ <br /> Signature Dat <br /> The issuance of a license under this ordinance shall be considered a prfvilege and not an absolufe right of the applicant❑ <br /> and shall nof enti�le the holder to an automatic renewa!o(fhe license. <br /> For Office Use Only: <br /> Reviewed by: Reconu ends: <br /> �Approval ❑ Denial <br /> _ __ . <br /> .. : ��cn ri..n.,..n.._f....,,.. n n �,..,r� r'�'.,,.+.:t�..., r�n.r cc��� r <br />