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For_ �ffice: U� <br />Compiiance Chec�C ID# ❑�[]��❑0 <br />Case #_ r'} 7, � Tobacco Compliance Ch�ck: <br />r <br />Comm�nity Arde� Hiits <br />orm <br />/ � <br />B�siness I�arne Arden H[Ils Tobacco � <br />�� � <br />Addr�ss 3673 Lexington Ave N � <br />Arden Hil�s, MN 55112 <br />Business type ❑Cor�venience ❑Conver�i�nc�lGas ❑Cas ❑Liquor <br />❑Drug s�vrelPha�-rnacy fobaccolSmoke Sho� []St�perrr�arke� iGrocery <br />I�BarlRestauran� OGenerai Mercha�t ❑Other {pri�ate c1ub, bowling, efc.) <br />Da�e ������000 <br />r� ml d d!y y y y <br />V11a�-purcF�ase att�mpfied? <br />�es ❑No <br />Buyer LJL� IL� <br />Llse 3 inifials <br />V�.V�,a� sale made? <br />j��'1'es ❑ido <br />Tir�� ���[�,] �m <br />If Na, c�eck r�ason: <br />❑Does not seii �obacco <br />❑Ou� ofi business <br />�After business hours <br />,�►ge �ex <br />❑'E 5 �Ferna4e <br />16 ❑Male <br />❑'f 7 <br />Vilas age as d? <br />❑Yes o <br />ad���Clu❑ <br />Use 3 in�fiaEs <br />_-__ __ _ __ _ -_- - . -- ' _i.`.;'"_.".._ - -- - <br />��� ., :� _ ' _ ' _ <br />❑Ur�satisfacforylunsafe candi�ions <br />❑Oth�r <br />❑�fof appiicable <br />�� <br />O�f cer�[]� <br />Use 3 initiaEs <br />Did aduEt af o€�icer vi�rn� tra�sactio�? <br />❑Yes �t�o <br />Was 1D reque ed? �fas I� sho n? <br />❑Yes . �o '�Yes [�o <br />Type af pt�rc�as� Type of tobacco eaduct Amounf Sp�nt �[��.0❑ <br />❑5e1 service Cigare��es <br />lerfc assisteci ❑5mokel�ss - � <br />❑V��ding machine-L�t�focked ❑Cigars <br />�Vending r�ac�t€ne-Locked ❑Other �cigare�te �apers, iigE�ter, etc.} <br />C�ark it�formation. ❑ �emale Male Name; <br />Harne address: Hom�: tefe�hor�e: <br />C �r: ta-a-��y� <br />PENALTfES: Cferk: Civif Penaity $fl0�❑ Criminai PenalfJ► $❑❑�❑ <br />Licer��ee-: C�vfI Penalty $�0�❑ LL 5�spensxon Di0 days �r less � j�11 to 3'� i#ays : . <br />� - _ _ �32 days to � -p�ar .-:. [�OVer � year - <br />For. Office llse: Orily - - . . - .: � . - . --. . <br />