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_ . � ' <br /> APPLICATION FOR LiCENSE TO <br /> ,�,p�. SELL TOBACCO PRODUCTS AND <br /> p � Q TOBACCO RELATED DEVICES <br /> e. <br /> (Ordinance No.164,Second Serles-Adopted 12108/97) <br /> � � <br /> '�`,�, ` �,ti�' Make check payable to: City of Orono <br /> �`�kEsHo4'� <br /> Mailing address; P.O. Box 66 <br /> Crystal Bay, MN 55323 <br /> FEE: $100.00 (February 1-January 31} _—j–�t�1�-� <br /> DATE <br /> 1. Applicant`s Full Name <br /> � �n� /l-� t� �f�� � � , <br /> SuzL� �:9�/ <br /> FIRST MI�DLE LAST <br /> 2. Applicant's Home Address <br /> $��(�� �ti9�avc�Urc:-c�� L ,� '7r�3— y�� �--s3��f <br /> HOUSE NUMBER STREET HOME PHONE <br /> �1�1�-PcrC=�2��c ,�1��� s s 3 j � <br /> CITY STATE ZIP <br /> 3. Applicant's Business <br /> c� <br /> ��N UCN (�ivC,� J�oR� �5,,� '' ��/'_ e3 `75r <br /> TYPE OF BUSINESS BUSINESS PHONE <br /> �'� �SLtLI_i v'/�nJ S 1T1,0 L1 h 63`� ��� � �C�'� ��tf�,%�L--lGtJ � LJ� <br /> BUSINESS NAME STREETADDRESS <br /> � .b , d r�X 6 � ./��/���'c= ��l� s.��39�-- <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 o�emp�oyee takes <br /> place. �'v, .�� �t � - .� =T.•Q � <br /> ' <br /> . � . <br /> 1 HEREBY MAKE APPLICATION FOR LICENSE TO SELL TOBACCO, TOBACCO <br /> PRODUCTS, OR TOBACCO RELATED DEVI CES AT THE ABOVE LOCATION SUBJECT <br /> TO THE LAWS OF THE STATE OF MlNNESOTA AND THE ORDINANCES OF THE ClTY <br /> OF ORONO. <br /> G�,�J�.-✓-�,,— j �r 0 I D �• <br /> Signature Date <br /> The issu ce o(a license under this ordinance shall 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 /> For Office Use Orily: <br /> Revie���ed by: � Recon ends: <br /> [�Approval ❑ Denial <br /> , . ;. . . . <br /> . . . . � � . � . � . . .n-icn r��-"---n--�--._.. .n n. T.,.. !G�!�.-.......t n....�TrtTr c<']'19� ' .. , � ,.. � . .. <br />