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► <br />1. <br />2. <br />4. <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AN] <br />TOBACCO RELATED DEVICES <br />(Ordinanct No* 1^ SccMid Stfits • AiUpUd 12/08/97) <br />Make check payable to: City of Orono <br />Mailing address: P.O. Box 66 <br />Crystal Bay, MN 55323 <br />J/Vi 0 <br />CITY Or GROy.O <br />FEE: $100.00 (February 1-January 31)/-7- 02. <br />DATE <br />Applicant's Full Name <br />ss<?./1 <br />FIRST MIDDLE LAST <br />Applicant's Home Address <br />'liO fi). ■Skcre> Qr.tJ- <br />HOUSE NUMBER <br />iTO OU <br />STREET HOME PHONE <br />mto -S>T34y <br />CITY STATE <br />3. Applicant's Business <br />GolL Orctrso-- ^7X- 3Vr9 <br />TYPE OF BU^NESS BUSINESS PHONE <br />V03* Art^tSr. <br />BUSINESS NAME ^ V <br />ItO AJ- lir -LJ <br />fViun.; -srjdV <br />STREET ADDRESS <br />S'S3(> V <br />MAILING ADDRESS CITY <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 />—* (fiKs 'ic> «■<-tricing • */cCjplace. CUiicint'- 4o tv-<;/o4r.frO ----------- ----- <br />ha^ •■yClA hair- i-fu-y iO-fl ffl A- <br />Cu4 j)ro4u<^ . <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 />A 7-0 2-- <br />Signature Date <br />TTie fjjuance of e Hbtnse under tfi/s ordBhence iheff be oonaiddivd e pdvffige andiwlefi ebeoftili dP^f of tfrt eppieanf <br />e/Nf a/MV nor encwe Ibe boldir le an eulometfo itneiee/of Ifie ioeoie. <br />121117 3 <br />1 <br />* S <br />; \