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<br /> <br />;(3-31-...<.Z, -,l"/- tit:'~ <br />.{J()..z? <br /> <br />tervi{{e <br />'EstaECisfux{ 1B57 <br />STATE OF MINNESOTA <br /> <br />1880 !Main Street . Centeroilk, 9vf!J{. 55038 <br />(651) 429-3232 .![aJ( (651) 429-8629 <br />CITY OF CENTERVILLE <br /> <br />COUNTY OF ANOKA <br /> <br />Application No. <br /> <br />RENEWAL APPLICATION FOR LICENSE TO SELL <br />TOBACCO PRODUCTS AT RETAIL <br /> <br />The undersigned, residing at I 6 g ~ 0 - X 2. 0 tV sf., in the City of III/J ~ () IJ t R <br />in the County of !J.ttJD It,4- . State of Minnesota, Residence Telephone: (~~)"3.y- 19 (, g HEREBY <br /> <br />MAKES APPLICATION FOR LICENSE to be issued to BILL BISEK, KELLy1S KORNER INC. DBA <br /> <br />KELLy1S KORNER B~ to sell tobacco products at retail at 7098 CENTERVILLEROAD, Business Telephone: <br /> <br />Q,jl) /'53- ?I'tl in the City olCentemlle, Anolra County, Minnesota for the term of one (1) year beginning with <br /> <br />__e 1st day of JtmU!l1'Y, 2004 , subject to the laws of the State of Minnesota and the ordinances and regulations of <br />said at,v ofCenterviUe pertaining thereto, and herewith deposit $75.00 in payment of the fee therefore. <br /> <br />Date: <br /> <br />By signing this renewal application, IIpplieant certifies thot there Iu1s been no clumge in OWflel'Ship, <br />corporoJe officers, or portnen. If changes have occurred during the past 12 months, complete in its tmtirety the <br />attached Tax Clearance Inf01'l1Ultion, then sign below. <br /> <br /> <br />f#-P~ <br /> <br />tJ// /'/1-""" 13,. s ~ 1< <br />Name (Print) <br /> <br />~pI <br /> <br />Z() 0.3 <br />, <br /> <br /> <br />Signature <br /> <br />;. t/; IltJf-z.- <br />tzJ '3 () 12PDD <br />