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1. <br />2. <br />3. <br />4. <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICESm(Ordinaries No. 164. Sneond Sorios • Adoptsd 1»ii)ft/97) <br />Make cheek payable to; City of Orono <br />Mailing address:P.O. Box 66 <br />Crystal Bay, MN 55323 <br />FEE: $100.00 (FehruMfy 1-JtinUary 31) <br />DATE <br />c <br />I r <br />Applicant's Full Name <br />________/’I _ <br />MIDDIE LASr <br />Applicant's Home Address <br />. Shy y •{ jtL <br />h|pusc NUMQEU nrRiiLT <br />^)y jkiJL:^yyy£L <br />HOME PHONE <br />/'hvL. <br />MAIL ZIP <br />^piicant's Business <br />-----------YPi A* mir.iNEss <br />gr\^. <br />nUSINrsS NAMF ^ <br />mv ciM &A <br />MAJLlNOAOUHL^a (J^ ^ <br />7^'2.- 7y>\z. ____ <br />UUrilNrSS PHONE <br />yy d* L* _____ <br />SI^LLI AODHESS <br />4:iiY n /' ZIP <br />Describe how the actual physical exchange of the tobacco, tobacco product, or <br />tobacco related devii^o between the customer and the licensee or employee takes <br />place, c ______________________ <br />I Hn<LHY MAKE APPIICATION FOP LICHNSE TO SELL TOnACCO, TOBACCO <br />PRODUCTS, OR TOBACCORFIAIEDDEVICBSAT THF. ABOVE I OCATION SUBJECT <br />TO THE LAVYS OF THF STA TC OF MINNFSO TA AND THE ORDINANCES OF Tl IE CITY <br />or ORONQT <br />A <br />hlgnantfif <br />y7/^xrl.x^L- <br />DahT <br />Uw Innimncm of a tlconum uniht ttUn onUnm^cn Bhotl Ps conaiilofmi a prfvffsga ami not mi nhnoiutn right of thn opf>ttCi»nt <br />mid itmB not mW§ ttm hotdm to mi mitomauc fi/Kiira/ of (f»# ficf/us. <br />------------^IPH