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1. <br />2. <br />4. <br />(P <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES <br />(Ordinanct No. 164, Sacond Sortot • Adopted 12/08/97) <br />Make check payable to: City of Orono q ^ <br />Mailing address: P.O. Box 66 Op <br />^004 <br />Crystal Bay, MN 55323 0/VO <br />FEE: $100.00 (February 1-January 31) <br />Applicant's Full Name <br />DATE <br />^ \ <br />V <br />HRST ~ ■ MIDDLE <br />Applicant's Home Address <br />C-^r\ <br />LAST’ <br />Appiicmt 8 Home Address . <br />HOUSK NUMBER v blKttl <br />V\vo <br />CITY X ^ STATE ^ <br />STREET HOME PHONE <br />ZIP <br />3. i^plicant's Businessmess <br />^ T i-L. wr DVidiixcoo - ^^ DuoimcDa rnuiMC ^ <br />BUSINESS NAME STREET ADDRESS . <br />VCl__________ VsV <br />CITY V ZIPMAIl INQ ADORF-SS <br />Describe how the actual physical exchange of the tobacco, tobacco product, or <br />tobac ............................................ <br />place. <br />tobacc o related di <br />■<>^X33eYisSL^ <br />I HEREBY MAKE APPLICATION FOR LICENSE TO SELL TOBACCO. TOBACCO <br />PRODUCTS. OR TOBACCO RELATED DEVICES AT THE ABOVE LOCAL ION SUBJECT <br />TO THE MWS OF THE STATE OF. MINNESOTA AND THE ORDINANCES OF THE CITY <br />OPORdNO: <br />Stgnakira <br />\^-l ■^o oH <br />DbIb~i V <br />1 he laatmHXolatcmm under this onUnancm that be contkitnd a ptMhgm and not an ^iokjfit light (i/maafipitrah f ’ <br />and ahaK not entitle the holder to an automatic renewal of the Ikenae.