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•3 <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES <br />(Ordinance No. 164, Second Scries • Alloptcd 12/08/97) <br />Make check payable to:City of Orono <br />Mailing address: P.O. Box 66 <br />Crystal Bay, MN 55323 <br />I'.v I <br />Cl I V w; ,'J <br />FEE: $100.00 (February 1-January 31)/- <br />DATE <br />1. Applicant's Full Name <br />2. <br />3. <br />4. <br />FIRST MIDDLE LAST <br />Applicant's Home Address <br />/af/jb-C do i^c\______ <br />HOUSE NUMBER <br />CITY <br />STREET lOME PHONE <br />kVjlAj <br />STATE ZIP <br />Applicant's Business <br />£ OF BUSINESSTYP <br />3,3lffO s^cfi.e.L\hi£=. <br />BUSINESS NAME <br />BUSINESS.PHONE <br />STREE <br />^7/ - <br />■ET ADDRESS <br />S^39fl , _ <br />MAILING ADDRESS <br />Describe how the actual physical exchang/ »f the tobacco, tobacco product, or <br />tobacco related device between the customs and the licensee or employee takes <br />place. y mTt^ ------------------------------—---------------------------- <br />/ HEREBY MAKE APPLICATION FOR LICENSE TO SELL TOBACCO, TOBACCO <br />PRODUCTS. OR TOBACCO RELATED DEVICES AT THE ABOVE LOCATION SUBJECT <br />/ -1^-99 <br />Date <br />The Issuance of a license under this ordinance shall be considered a privilege and not an absolute right of the applicant <br />and shaO not entitle the holder to an automatic renewal of the license. <br />121197.3