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1. <br />2. <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES <br />Eili <br />(Ordlmnct No. 1(4, Sccood Strics • 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: $100.00 (February 1-January 31) <br />DATE <br />Applicant's Full Name Wa /la/i e <br />FIRST MIDDLE LAST <br />M/inKli^rr <br />HOUSE NUMBER <br />Applicant's Hoipe Address • . <br />___ Hill <br />Lon A _ ^ <br />STREET <br />5535^ <br />Qc^a- 4*73->^36 <br />HOME PHONE <br />CITY STATE <br />3. ApplicMt'fLBusinessPPlifiW«>.ousinc <br />(\‘3Q - i?49-Q35f) <br />BUSINESS PHONETYPE OF BUSINESS , BUSINESS PHONE. . I I I J <br />Liflijor ly\a^ 2 \U> W. MajJFAln mVd. <br />I?5IKJPQ<; WAMP i . STREET ADDRESS I1ISINESS NAME . _ . <br />T*- O. Took 3 O Co __ <br />MAILING AO&RESS <br />STREET AOOREp V <br />ionauu^.Mn 5^35 6. <br />ITV ^ t—— —CITY <br />Describe how the actual physical exchange of the tobacco, tobacco product, or <br />tobacco related device between th^ustomer and/th^icensee or employee takes <br />I. Qj I .'H nr.' Cj\^ hJ-AM o \ T }.u‘- t ^place. ('j / .'HhJiAM C.l\~\ ua - ^ a aA t /c^ <br />i\.j Tir-01 I rVi / j c\ ■ TiLr tc <br />rf ii/r . jf?-/u*i'/'» t <br />/ HEREBY MAKE APPLICATION FOR LICENSE TO SELL TOBACCO. TOBACCO <br />PRODUCTS. OR TOBACCO RELATED DEVICES AT THE ABOVE LOCATION SUBJECT <br />TO THE LAWS OF THE STATE OF MINNESOTA AND THE ORDINANCES OF THE CITY <br />OF ORONO. <br />Signature Date <br />n»iisuanc9 eta Scent* undtrthis ofJintnetaMb»eonsia»nd»pfMtg»$nanot tnabsohO$ right eHh§§fifi8ctnt <br />*ndahaSnot*ntltl*lh*hckhrlo*n*utetn*tlemne*mleflh*So*nae. <br />utitrs <br />—**"-----I