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. l � <br /> ����d��� <br /> APPLICATlON FOR LICENSE TO�AN .� 7 z0�s <br /> ,¢, p�. SELL TOBACCO PRODUCTS��X����o <br /> O � O . TOBACC4 RELATED DEVICES N� <br /> (Ordinance No.164,Second Series-Adopted 12/08/97) <br /> e <br /> 1'� � <br /> �',�, �titi Make check payable to: City of Orono <br /> �`��EsHo�'`'� f��� �-7,,�.`� � <br /> Mailing address: P.O. Box 66 <br /> Crystal Bay, MN 55323 <br /> FEE: $100.00 (February 1-January 31) �� v�' <br /> DATE <br /> 1. Applicant's Full Name <br /> �:��.�--- ��-2� �---. <br /> IR MIDDLE LAST <br /> 2. Applicant's Home Address <br /> .���rx��; , ��: ,,�/c�� �%� �.� � - � s�`�"� <br /> HOUSENUMBER STREET HOMEPHONE <br /> • -2 � �,�--- 2�� '��/�— <br /> � CITY � STATE ZIP <br /> 3. pplicant's Business <br /> � :�v �=�— z.�.�_ '� ��,1 — 7 s�>�c�' ��g <br /> TYP� F BUSINESS BUSINESS PHONE ,/ <br /> /,� ��/�� J�'�]r �/ � / /j���.y� �/J�j, I/��/ y)��^� <br /> `!l ���- � I�� ''_' ✓�4��� �����' f�( �� VVµ� i��'(/�"L'1 ( /w�Y <br /> USINESS NAME STREET ADDRES <br /> � c 7/Li`_ " LE1 ^✓V`' ��� <br /> MAILING ADDRES � CITY ZIP <br /> 4. Describe how the actual physical exchange of the tobacco, tobacco product, or <br /> tobaGco rela#ed device between the�stomer and the licensee or employee takes <br /> p l a c e. �.�-���� C�� �.-t-�� <br /> I HEREBY MAKE APPLICATION FOR LfCElVSE TO SELL TOBACCO, TOBACCO <br /> PRODUCTS, OR TOBACCO RELATED DEVICESAT THEABOVE LOCAT(ON SUBJECT <br /> TO THE LA WS OF THE STATE OF MINNESOTA AND THE ORDINANCES OF THE CITY <br /> OF ORONO. <br /> ' � �?�����-`� / �� ��.. <br /> Signa ure D te <br /> The issuance of a license under this ordinance shafl be considered a privilege and not an absolufe right of the applrcant❑ <br /> and shall not entitle the holder to an automatic renewa!o/the license. <br /> For Office Use On]y: <br /> Reviewed by: ,� �� Rec�}m,,mends: <br /> Ll Approval ❑ Denial <br /> , _ _ . . <br /> . . � ' �. ... � � ���cn v.,11,,..�...-1,,...,.. U Il D.,.. !.!, !�.-..�*�1 A"� TR7.T[GZ'7� .. .. � . . . ... �. <br />