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1. <br />2. <br />3. <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES <br />(Ordlaaiicc No. 164, Secooil Series - Adopted 12/06/97)o <br />Make check payable to: City of Orono ’/•I v 0 q <br />Mailing address: P.O. Box 66 <br />Crystal Bay, MN 55323 <br />CJ/ y U- <br />FEE: $100.00 (February 1-January 31) <br />Applicant's Full Name <br />//.( <br />FIRST r MIDDLE LAST <br />Applicant's Home Address . <br />2.(0 ________OAC: /tKd^ S,(-.6S'hiz2- s/o y <br />HOUSE NUMBER STREET <br />/ifa/ <br />HOME PHONE <br />CITY STATE <br />Applicant's Business <br />V7?- /Too <br />TYPE OF BUSINESS <br />BUSINESS NAME <br />(o U/A'JT^fr>j 3*!f <br />MAIUNG ADDRESS ~ <br />BUSINESS PHONE <br />L <br />STREET ADDRESS ' <br />Ia/Avt^-^a. <br />CITY ^ <br />6^39 / <br />ZIP <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, IT 2t,k]/yX 4 be. <br />4 H A...A /. 4 U. aASAe.JtA_______________________________________________ <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 />Signature 4^d2_ <br />The issuance of a licanaa unaarthia ordinance ahall ba eonaUamd a prMaga md not an ^aohita right of lha appSeant <br />and^ta8notanWathahMartoanautom^ranawalofthatoanaa. <br />121 tars <br />T <br />I; <br />i