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l� <br /> APPLICATION FOR LICENSE TO <br /> ,�, p�. SELL T�BACCO PRODUCTS AND <br /> p Q T�BACCO RELATED DEVICES �� <br /> (Ordinance No.164,Second 5erles-Adopted 12/08/97) ��� <br /> � �� - � �q�� ���'��� <br /> '�`,�, �ti Make check payable to: City of Orono o C � <br /> L`�kEsxo�``'� �G '� ;�.��`�l I �T1'��� ��06 <br /> Mailing address: P.O. Box 66 �p� <br /> Crystal Bay, MN 55323 � <br /> FEE: $100.00 (February 1-January 31) /—/o-0 6 <br /> DATE <br /> 1. Applicant's Full Name <br /> �c�i liac� //I ��N <br /> FIRST MIDDLE LAST <br /> 2. Applicant's Home Address <br /> HOUSE NUMBER STREET HOME PHONE <br /> CITY STATE ZI P <br /> 3. Applicant's Business <br /> ���uNfu e�uh ys�- �7.�= ���6 <br /> TYPE OF BUSI ESS � BUSINESS PHONE <br /> w�Z�-�'�- �ww �y e.,C�,� _ao� w,�Z��- 8��� �� <br /> BUSI ESS NAME STREET ADDR SS <br /> v�G �lJ 4v 2 ra-�•4� �I J rQ (,() ��V Z..�i-�/Y � �f.✓ S.�8 9 l <br /> MAILING AD RESS CITY ZIP <br /> 4. 'Describe how the actual physical exchange of the tobacco, tobacco product, or <br /> tobacco elated device between the customer and the licensee or employee takes <br /> .place. �a��a-�� ��a»� �i�uT��� <br /> 1 HEREBY MAKE APPLICATION FOR UCENSE TO SELL TOBACCO, TOBACCO <br /> PRODUCTS, OR TOBACCO RELATED DEVlCES AT THEABOVE LOCATION SUBJECT <br /> TO TNE LAWS OF THE STATE OF MINNESOT,4 AND TNE ORDINANCES OF THE C1TY <br /> OF ORONO. <br /> /-7G-e� <br /> 5ignature Date <br /> The issuance o/a license under this o�dinance shall be conside�ed a p�ivilege and not an absolute right o(the applicant❑ <br /> and shafl not enlitle the holder to an automatic renewa!of the license. <br /> For Office Use Only:,, i <br /> Reviewed by: 'r Rec nunettds: <br /> Approval ❑ Denial <br /> . :• - : <br /> . . . .. . . � � . �n^icn v_tt"-n.._��_.__. n n n.... GG �/�....,,a,.7 0...� T..f'AT CG47�. . . . .. - .. . .. . . <br />