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APPLICATION FOR LICENSE TO <br />SELL TOBACCO PRODUCTS AND <br />TOBACCO RELATED DEVICES <br />(Ordinance No. 164, Second Series - Adopted L2/08/97) <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)(OnA /9'9^ <br />DATE <br />1. Applicant's Full Name <br />FIRST <br />f clOLLAQB (J>) L-3R <br />MIDDLE LAST <br />2.Applicant's Home Address <br />3(cD l4r/('X b&z'rQ U/lL_______ <br />HOUSE NUMBER ^ STREET <br />Lr-,Y\n iriUQ. ynn <br />HOME PHONE <br />CITY STATE <br />3. <br />4. <br />Applicant's Business ^ <br />/.in^UnQ ^-tcR/= ____ <br />TYPE OF BUSINESS BUSINESS PHONE <br />U/0(Ia9. .XnC . .QlC=6 U) iiJa(j7.aiu t>LuD <br />' STREET ADDRESS <br />Py). 3dX 3Q(=_______ z.<onn nm -^~3 <br />MAILING ADDRESS CpTY ^ ZIP <br />Describe how the actual physical exchange of the tobacco, tobacco product, <br />tobacco related device between the customer and the licens^ or employee tal <br />BUSINESS NAME <br />Describe how the actual physical exchange of the tobacco, toE <br />tobacco related device between the customer and the licens^ o <br />Place. .IFlV h ldu^^___^ <br />(^/'r^rrs r pr>(^Au<Uf- 1 c/f! oi <br />' ' ' — <br />or employee takes <br />" r C'/qr/rr^ <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 />r <br />Signature <br />36 no/ <br />Date <br />The issuance of a license under this ordinance shall be considered a privilege and rot an absolute right of the applicant <br />and Shalt not entitle the holder to an automatic renewal c* the license. <br />1211973