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��'i��BVLC.� <br /> �AN .� 2 zoos <br /> APPLICATION FOR LICENSE TC� <br /> / p SELL T�BACCO PRODUCTS ANC�F �RQN� <br /> � �Q TOBACCO RELATED DEVICES la <br /> O <br /> (Ordinance No.164,5econd Serles-Adopted 12/08/97} <br /> , . <br /> �',�, �ti`� Make check payable to: City of Orono , •�.'1�''�� <br /> L�kESHo4� �� <br /> Mailing address: P.O. Box 66 <br /> Crystal Bay, MN 55323 <br /> FEE: $100.00 (February 1-January 31) '� � � " ��_ <br /> DATE <br /> �I. Applicant`s Full Name <br /> �n� �.z.v- t���t-�� S���S t l�� v <br /> FIRST MIDDLE LAST <br /> 2. Applicant's Home Address <br /> ( 4525 ��� � `� 5Z �� L�s� <br /> HOUSE NUMBER STREET HOME PHONE <br /> ���{v t�'�'rt,�V_Ft- V"`s.� ����7 <br /> C�TY STATE ZIP <br /> 3. Applicant's Business <br /> Q�'�c.�� C`�-Y��;� S�� I C �'�Lt YvV�G�L� BUSINES�S PH�E � 3� V Q <br /> TYPE OF BUSINESS <br /> S'►'�y l�r�-�-- p�-�� Str�1�= #.7�D 2-� _ <br /> BUSIN S5 NAME � STREET ADDRESS <br /> 7 3�a 5��-1�-o�v��a� R� ��r_o�0 ���1 ���cl I <br /> MAILING ADDRESS ClTY 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 /> � <br /> place. c�,hr•� �� ������-4z-� �--� C'���r,l� -�-o-r �-v>�-t-,v� ���a����r.-��; <br /> -�j l� U � �J1 �u-���l � <br /> 1 HEREBY MAKE APPLICAT/ON FOR UCENSE TO SELL TOBACCO, TOBACCO <br /> PRODUCTS, OR TOBACCO RELATED DEVICES AT THEABOVE LOCATfON SUBJECT <br /> TO THE LAWS OF THE STATE OF MINNESOTA AND THE ORDINANCES OF THE CITY <br /> OF ORONO. <br /> � ---�= J- �� -��ti <br /> / Date <br /> The issuance of a/icense under this ordinance shall be considered a privilege and not an absolute right of the applicant❑ <br /> and shall not entitle the holder to an automatic renewal of the liconse. <br /> For Office Use Only: <br /> Reviewed /J Reconunends: <br /> �'� �./� �Approval ❑ Denial <br /> ._ .. . . . _ . _ .. <br /> ��cn v..t�,...n,...i..,..,.. D(� D.,..!.r (`.�.,�+.,1 v.;,, aa't.r c«�� <br />