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1. <br />2. <br />APPLICATION FOR LI <br />c}i~ <br />i\rji lY <br />ISELL TOBACCO PR >'■’ , <br />L ,n V‘2i: H' l. ITOBACCO RELATED <br />(Ordinaries No. 164, Second Seriat <br />Make check payable to: City of Orono <br />I /<>/ <br />Malting address: <br />FEE: $100.00 (February 1 -January 31) <br />Applicant’s Full Name <br />J.mcs DUf^ine <br />FIRST <br />Applicant’s Home Address <br />20 Clay Cliffo Drivo <br />HOUSE NUMBER <br />M'OOLE <br />P.O. Box 66 <br />Crystal Bay, MN 55323 <br />_JanuarY_13, 2005 <br />OAfE <br />LAST <br />ciTY <br />STREET <br />Minnosota__ <br />STATE <br />952-470-9951 <br />HOME PHONE <br />55331 <br />^IP <br />3. Applicant’s Business <br />Par/Restaurant_ <br />TYPE OF BUSINESS <br />952-471-3352 <br />Narrows Salcxm <br />BUSINESS NAME <br />Sane <br />BUSINESS PHONE <br />3380 Shoreline Drive <br />MAILINO ADDRESS <br />STREET ADDRESS <br />Orono, Minnesota <br />clfY ■ ~ <br />55392 <br />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. Cigarettes arc kept bchiixl b.ir. Patrons must purchase fion either <br />Uirtondar or waitress ~~ <br />I HtKtBY MAKE APPLICATION FOR LICENSE TO SELL TOBACCO. TOBACCO <br />PRODUCTS, OR TOBACCO RELATED DEVICES AT THE ABOVE LOCATION SUBJECT <br />TO THE LAWS OF THE STATE OF MINNESOTA AND THE ORDINANCES OF THE CITY <br />OF/ORONO. <br />Slgnalura Dale <br />imiOn& d § Kcmm under INa ordkiance ahek be conakhned a prMhge and not an abeoMa dgMofthb ^f^lcant <br />and ahan not entitle the bolder to an mjdomatkiwmwal of the Ucenaa, <br />t m <br />la