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« • <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: Cit}' 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 />FIRST 7 <br />Aiik <br />MIDDLE LAST i- <br />Applicant's Home Address <br />___C. A*/€ <br />HOUSE NUMBER <br />CITY <br />STREET <br />/H aJ_____crit ^ <br />HOr/E PHONE <br />STATE <br />Applicant's Business <br />Qrt j4^ CfuR <br />TYPE OF BUSINESS <br />> 4^ -7 ? " /ro <br />Sf (i M // (n,!h' CL /'? <br />BUSINESS NAME <br />72 >" ilk k <br />MAILING ADDRESS ^ <br />TREET ADDRESS ' <br />.'C. <br />ITV' f * %iD <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.__lO/ic Uti ^ ____________ <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*gnityroity?o »Da:e <br />7/jo issuance of a hcensa under this ordinance shall be considered a privilege end not an absolute fight of ffte applicant <br />and shaft not enbUe the holder to an automatic renewal of the license <br />i^ 2750.Kelley Pirkwty, P.O. Box 66» Ciystil Bay. MN 553M o V <br />J