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1. <br />2. <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES <br />(Ordinanct No. 1(4, Smod Stria • Adopted U/OI/97) <br />Make check payable to: City of Orono <br />Mailing address: P.O. Box 66 <br />Crystal £ay» MN 55323 <br />FEE: $100.00 (February 1 -January 31)/- /‘/ox. <br />DATE <br />Applicant's Full Name <br />fVL g.5________ <br />RPH' <br />FIRST <br />a MIDDLE LAST <br />Applicant's Home Address <br />HOUSE NUMBER <br />tyf)cL^ w <br />CITY <br />STREET <br />- too'/ <br />HOME PHONE <br />STATE 53^ <br />3. Applicant's Businesspplican <br />nci / <br />TYPE OF BUSINESS . <br />hjUDS .5ql /< <br />BUSINESS NAME <br />0£>h <br />HI I <br />ISINESS PHONE ' - y / <br />iP/W <br />STREET ADDRESS <br />PP. i>o\t 3h ^/JoudCx //d Ifin. <br />CITYMAILING ADDRESS <br />Describe how the actual physical exchange of the tobacco, tobacco product, or <br />tobacco related device between the customer and ^e li^nsee or ^plovoe takes <br />pla^e.—JLJ4.ice.___wm <br />ween the custor^r and^e li^nsee or ^[ipl^j^^ke! <br />I 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 />/ - /V <br />Data <br />TTm luuanct of a licanM undar tfita onCnanco s/iad 6o consMaotf a prfvBaga and not an absoMa of 0>a dppficanf <br />antf aftaf fwT anfitlit tfia iwMar <0 an awlomaife wiawai or Ma ieanaa. <br />nitra <br />i