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1. <br />2. <br />3. <br />4. <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES <br />(Ordinance No. 164, 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 o1) <br />DATE <br />Applicant's Full Name <br />----------------------------- <br />FIRST <br />Quah t.A^ <br />MIDDLE <br />Applicant's Home Address <br />^9 0 L^utix. <br />HOUSE NUMBER <br />yy ctiCi. <br />LAST <br />STREET HOME PHONE <br />ttJ! <br />7/i <br />CITY STATE ZIP <br />Applicant's Business <br />TYPE OF BUSINESS <br />0.' <br />BUSINESS NAM <br />l/yihA i <br />sname’ <br />o u. <br />C,!D ' <4ll -3 J5X. <br />BUSINESS PHONE ,v / / <br />3 "gr? <br />P. O. Oo-v <br />,Iaii Annocce/^ <br />STREET ADDRESS <br />MAILING ADDRESS' CITY <br />Describe how the actual physical exchange of the tobacco, tobacco product, or <br />tobacco related device between the custoer and the licensee or employee take^ <br />place. ToLa./ / ri /5 -----QSslJL-----1/" <br />OF ORONO. <br />Date <br />The issuance of a license under this ordinance shall be considered a privilege «PP»car>f <br />and shall not entitle Uie holder to an automatic renewal of the license. <br />121197 3