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16 <br />oT o <br />Cl l Y Ur Vi/,T, <br />1. <br />2. <br />3. <br />4. <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES <br />(Ordiaanct No. 1<4, Second Series • Adopted 12/08/97) <br />Make check payable to: City of Orono <br />Mailing address: P.O. Box 66 <br />Crystal Bay, MN 55323 <br />FEE: $100.00 (February 1-January 31) <br />DATE <br />Applicant's Full Name <br />FIRST MIDDLE LAST <br />Applicant's Home Address <br />HOUSE NUMBER STREET <br />7kV*ia>-5S7l <br />HOME PHONE <br />5530S <br />CITY STATE <br />Applicant's Business <br />Cc lrv>ig.lrv\p rvC *SVd( <br />TYPE OF BUSINESS <br />VjL^g&Wcrv feY\v)PrNidrvC^ <br />BUSINESS NAME <br />fpYl ^VtfWLV\CvrvS>V.____ <br />MAILING ADDRESS <br />95,?-7^5-0H‘78' <br />li^aiJTrL^L Lfina WLe <br />STRECT ADDRESS J ^ 55356- <br />^ Mia 55303 <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.______^ir/‘VvtLS^■ fiV <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 />Data <br />ilnlo9i <br />Tfta IsatMflca oTa fcanaa undlar IMt onftianca aftaf 6a cona«dla/ad a ivMiaga andM( an abaoArf* r^t or tfta iinpScarrt <br />and alial not andltfa tfw/>oMaf 10 an automatfe/wiaiM/or tfw ioanaa. <br />tsiiari