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f <br />1. <br />2. <br />3. <br />4. <br />W: <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES <br />(Ordinance No. 164, Second Series - Adopted 12/08>97) <br />Make check payable to: City of Orono <br />Mailing address:P.O. Box 66 <br />Cr>'stal Bay, MN 55323 <br />FEE: $100.00 (February 1-January 31) <br />DATE <br />Applicant's Full Name <br />6 Su <br />FIRST MIDDLE LAST <br />Applicant's Home Address <br />HOUSE NUMBER <br />fi STREET <br />A\ ,y/ <br />HOME PHONE <br />5>'^9 ft <br />CITY STATE <br />Applicant's Business <br />(Zt m i/tTA^ i(cUC C-"~ <br />TYPE OF BUSINESS <br />G SltL Li <br />V^2. - W 7 f- -z <br />BUSINESS NAME <br />MAILING ADDRESS <br />BUSINESS PHONE <br />3U'C O "!> <br />STREETADDRESS <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. c aA'Uyiv^ _________ <br />/ HEREBY 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 />S«gnaturt J Date <br />TTw Issutnct Oft lictnst undar IM ofdinsnca shall ba comiOatad a ptMaga and not an abatMa right of dm appdearri <br />and ahat not anbtta tha holdar to an automatic nnawal of tha ticanaa. <br />i ■ ■ • v:; •. -"-2750 KeliorPirkwtyiT.O.'Box <6. QysUl Bay. MN 55323 -■ w v ^