Laserfiche WebLink
O <br /> APPLICATION FUR LICENSE TO <br /> ,¢,p�, SELL TOBACCO PR(�DUCTS AND <br /> p � Q TOBACCO RELATED DEV10ES <br /> (Ordinance No.164,Second Series-Adopted 12/08/97) <br /> ° - , ? <br /> �`.�, �ti Make check payable to: City of Orono �,�, :����J <br /> L�kEsxa�"� � <br /> Mailing address: P.O. Box 66 <br /> Crystal Bay, MN 55323 <br /> FEE: $100.00 (February 1-January 31) L�o�v� <br /> DATE <br /> 1. Applicant's Fuil Name <br /> � �'�f� �l I G N���L � �S��t i c._l c?�3�tl <br /> FIRST MIODLE LAST <br /> 2. Applicant' Home Address <br /> �"� y`7 f?at,o c rF v��a✓ ,��/ 7(� 3 �- �/'�?'G� ��.a:5� <br /> HOUSE NUMBER STREET HOME P1iONE <br /> �J�f�LE C�vd�: �Z��W SS�3�l <br /> CITY STATE ZIP <br /> 3. Applicant's Business <br /> 1...�fU U�N ll—,'NCl �'I D�L� �� � " L�'7 I '' c� .3�'l�- <br /> TYPE OF BUSINESS BUSINESS PHONE <br /> �,� [� 7 n <br /> j �SCt C.i�I V,r9 NS /Y E� L I f�A\' ��/�� r���U �lffi��Y'u°i�'• D � � <br /> BUSINESS NAME STREET ADDRESS <br /> �- (�, � �� �' � S� JI/�(/��.k'L �rL� ��`^3% Z <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 /> place. �A1 P�.u-��c;� ���R I �=i�S LC:=lri5` � Cc� S•���c�'t �-G'I�c'-'s <br /> t'�rD�L(G`i TO '1'If E/�1 <br /> l HEREBY MAKE APPLICATION FOR LICENSE TO SELL TOBACCO, T08ACC0 <br /> PRODUCTS, OR TOBACCO RELATED DEVlCES AT THE ABOVE LOCATION SUBJECT <br /> TO THE LAWS OF THE STATE OF MINNESOTA AND THE ORDINANCES OF THE CITY <br /> OF ORONO. <br /> �'J � <br /> �v� L/ ,�.L,G,�z-'� /'o O .� <br /> Signature Date <br /> The issuance of a license under this ordinance shalf be considered a privllege and not an absolute right of the applicant❑ <br /> and shall not entitle the holder to an automatic renewal of the license. <br /> Far Offce Use Orily: <br /> Revie�ved by, /� Reco�nds: <br /> �,�� Approval ❑ Denial <br /> _ ,...,..._. „ „ , „ „ r ,. � .._, „_.. �,,., <<.,.,., <br />