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1. <br />2. <br />3. <br />4. <br />ot <br />APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND^.o^ <br />TOBACCO RELATED DEVICES \ <br />U <br />:sH <br />(Ordinance No. 164, Second Series - Adopted 12J0BI97) <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 />Applicant's Full Name <br />^----------------------------------------FIRST MIDDLE <br />Applicant’s Home Address <br />L Ct In I <br />LAST <br />HOUSE NUMBER STREET <br />A/J~ <br />HOME PHONE <br />CITY STATE <br />Applicant's Business ^,fJ'7Y<r-OH7? <br />TYPE OF BUSINESS <br />BUSINESS NAME <br />BUSINESS PHONE <br />Po 3o)c 3^0 <br />STREETADDRESS <br />OntJOmMAIUNG ADDRESS <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 />------------------------------- ^ ^ <br />=»--WiC <br />r/ffTr <br />I HEREBY MAKE APPLICATION FOR UCENSE TO SELL <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 <br />The Issuance of a Bcense under this oaSnsnee shall be considered a ptMlege ai^ not ^bsolute right of the applicant <br />andshaOnot entitle the holder to an automatic renewal of the Bcense. <br />121197.3 <br />I