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2. <br />3. <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AN <br />TOBACCO RELATED DEVICES , 4 <br />(Ofdln^inc# No. 164, Socond 8#rkii - Adopted 12A>8/97) <br />Make check payable to: City of Orono <br />Mailing address:P.O. Box 66 <br />Crystal Bay, MN 55323 <br />o\“^/ <br />FEE: $100.00 (February 1-January 31) <br />DATE <br />.1iluh <br />1. Applicant's Full Name <br />Thtf/J <br />IIHST MIPDIF. <br />^ 'Sm.i <br />LAST <br />Applicant's Home Address <br />HOUSE NUMHKH <br />Mnc6'^(/c <br />CITY <br />CTREET HOME PHONE <br />2^. <br />SIATi: <br />JT:r.JLL _ <br />Applicant's Business <br />Qjf ni i/L-/o hu /Oc . iT S\ <7^ l'" <br />TYPE 01 BUSINESS......... <br />11 nojjM <br />IS NAME <br />Vrp.- rC <br />HUSINKSS PHONE <br />fiOjj oOX.BUSINESS NAME <br />MAIL INO ADDRESS.......... <br />StiAh'^UftO p_dp <br />STTTEET ADDRESS <br />- ........................5ii 3fZ- <br />CITY <br />Describe how the actual physical exchange of the tobacco, tobacco product, or <br />tobacco related device between the customer and the licensee or employee takes <br />place. (\a^H u 'R /yiwr HA/Jo __LLLAA__~ e <br />_______7 fo H________________________________ <br />I HCRHUY MAKF. APPLICATION FOP LICLNSE TO SELL TOBACCO. TOBACCO <br />PRODUCTS, OR TOBACCO RELATED DEVICES AT THE ABOVE LOCATION SUBJECT <br />TO THE MIfVS OF Tl IE STATE OF MINNESOTA AND THE ORDINANCES OF THE CITY <br />OF ORONO. <br />Date <br />f/ty <br />Ifm inmirnym of a It^nm t/ndpr thl$ ortlfnmm ^nlt b$ Ginikfemd a ptMhgo at}dnoi an abaoluh Hifht ofiha <br />and ahaff noi anfHia tha hokhr to an aufomaUc mnaami of lha Uoanaa. <br />n ir^Ti^rinTTViv^ iii^rfirriiniTfiirifh ri ■ ^ 11 nibiiri MwmiBUt HjinmiiM