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rr <br />1. <br />2. <br />3. <br />4. <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 />Mailiog 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 />*SoffrJ <br />FIRST <br />A\fCF/Agc <br />MIDDLE <br />0 'S <br />UST <br />Applicant's Home Address <br />^0^1 (tAAJCHi/lirLJ <br />HOUSE NUMBER <br />A1/^ <br />'•T t STATE <br />STREET <br />5"£TJ9Z <br />HOME PHONE " <br />Applicant's Business <br />_ letJc cr 3tc Ji. t- <br />TYPE OF BUSINESS —d's. <br />9S-Z-V7// <br />A <br />^ L I \,'A a/ <br />BUSINESS NAME <br />BUSINESS PHONE ---------------------------- <br />2Ulo8t^fiei.,^e b <br />MAILING ADDRESS <br />STREET ADDRESS <br />/1)A(//9AA(' <br />/?! OLr <br />CITY <br />P'**®®'------Gt/ yrc^M^ A flp: /I IJ f srr- c c t r^c/*^ C/is <br />I Ht-REBY MAKE APPLICATION FOR LICENSE TO SELL TOBACCO TOBACCO <br />PRODUCTS. OR tobacco RELATED DEVICES AT THE ABOVE LOCATION SUBJECT <br />OF the STATE OF MINNESOTA AND THE ORDINANCES OF THE CITY <br />Signalur^^ ’//z. i/o') <br />Date <br />• ».*r* — <br />; .V ■ • 4 Cost-i BayTMfTslIairrrplTr:;;^ .:v ’ ;j