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r <br />5IIWHO <br />APPLtCATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES <br />(Ordiruinco No. 164, Sacond Sarlos • Adoplad 12/08/07) <br />c® <br />Make chock payable to: City of Orono <br />\o ‘) <br />\ <br />'V <br />Mailing address:P.O. Box 66 <br />Crystal Bay, MN 55323 <br />FEE: $100.00 (Fobninry l-J/jnuury 31) <br />1. Applicant's Full Name <br />.. ........... /?11 f"-///) 11 <br />fiioi Minnie: <br />2. Applicant's Home Address <br />—jJihI< <br />OAIC <br />0 ,Sm/ <br />IASI <br />Mouse : Nl IMI It H SI Ml I r <br />_ '/U S f* - s vn <br />UOMLI'IIONE <br />/H/IPu' 6'a‘ov'l'" <br />OIIY <br />A/ji/ <br />OfATU <br />5 5* .31 I <br />Zll* <br />Applicant's Business <br />A/l/l AiiC/0C\j^ ^ <br />7YPI . OF BU31NI OS <br />^'tV((e« u v/,v V /{eL \(y/\x <br />HUSINI SSNAMl <br />MAii iNOAnnierss <br />.C’ <br />ilUSINI SSI'UONI: <br />fy !>U0 SVt»/<fC. t e iv^ t"' J)r t c»t' <br />siMi-e I AunRi'ss <br />/\/6 5 Vin'I- <br />CIIY ' /ll» <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._____LIAI*<• \v'Rv H/Mfbi Ci<*;'i'r»n«,g r io/a a'i^> ____ <br />JliZ.....•/1 y _ <br />/ ill Rim MAM APPUCATION FOR ilClNSp lO Sill lOLiACCO, TOBACCO <br />PRODUC1S. OR TOBACCORPLATLODlrVICt SAI IHLAliOVCLOCATIONSUBJtCT <br />10 WLLAWSOrTlir-.SIAlPOF MINNI SOTAANn TUP: ORniNANCI SOF THFCIIY <br />or ORONO <br />Cilgnnhrrn <br />/k <br />Dutii <br />or <br />Mm /amMWN V < 1/« Ai wim iHKtat lhi» iwiAianc* than ha conOifafad a piMlena and not an adau/utt m^kant <br />and that nol antida lha hohJar lu an autnmaik lanawal nt dta Ucmnaa. <br />It* Mriwoaaf ttWEiWig ivn-.c^aT.:ur»::a ’...-aggtrA a a>>;ia5vWusvT.Ki »«o »