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1. <br />2. <br />4. <br />akiiS <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES <br />(OrdlnaactN*.lM,SwMi4S*ritfAdoptedU/OI/f7) * <br />Make check payable to: City of Orono I 4 . <br />Mailiog address: P.O.Box 66 <br />Crystal Bay, MN 55323 <br />FEE: $100.00 (February 1-January 31)/- <br />DATE <br />Applicant’s Full Name <br />-----------------------------U .i ^ <br />first r MIDDLE <br />Applicant's Home Address <br />LAST <br />h ^u IenE NUMBER STREET HOME PHONE <br />tvT /7 tM d <br />CITY STATE <br />3. Applicant's Business <br />C.T-U-~r f^K/ <br />TYPE OF BUSINESS BUSINESS PHONE <br />BUSIisiN eSsname ' <br />TOiv> <br />STREET ADDRESS <br />DRESS CITY <br />hnut. <br />ZIP <br />Describe how the actual physical exchange of the tobacco, tobacco product, or <br />tobacco related device between the customer and the licensee or employee takes <br />Place. ._________________________________________ <br />/ HEREBY MAKE APPLICATION FOR UCENSE TO SELL TOBACCO. TOBACCO <br />PRODUCTS. OR TOBACCO RELATED DEVICES AT THE ABOVE LOCATION SUBJECT <br />TO THE LAWS OF THE STATE OF MINNESOTA AND THE ORDINANCES OF THE CITY <br />OF ORONO. <br />Signanire Data <br />77m Issuance of a Ucansa uiHitr M$ onfinanca $ha9 bo oonaklond a ptMogo and not an ^soluta right of rim apfiOcant <br />antf afwff not anriria rim holriar to an aolomatte mnawal of rim teanaa. <br />1211171 <br />lowafft