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<br /> <br />ervi{{e <br />~1B57 <br /> <br />1880 Main Street . Centeroille, 9vf.9il. 55038 <br />(651) 429-3232 .!faJC (651) 429-8629 <br /> <br />STATE OF MINNESOTA <br /> <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 .r;l/9.5 J S1'-' S1'".. III <br /> <br />in the City of <br /> <br />J-II.I~{) <br />. <br /> <br />in the County of /J/AS t+/,.tJh f'tY~ State of Minnesota, Residence Telephone: (6fI)-.Yt1J:. 7./0 J <br /> <br />HEREBY <br /> <br />MAKES APPLICATION FOR LICENSE to be issued to TERRY SAGER, SAHAWK INC. DBA SAGER'S <br /> <br />LIQUOR, to sell tobacco products at retail at 7093 20TH AVENUE SOUTH, Business Telephone: (Jfl )YJL- <br /> <br />-- <br /> <br />/4;l:L in the City ofCenterville, Anoka County, Minnesota for the term of one (1) year begjnning with the 1st day <br /> <br />of January, 2004, subject to the laws of the State of Minnesota and the ordinances and regulations of said City of <br /> <br />CenterviUe pertaining thereto, and herewith deposit $75.00 in payment of the fee therefore. <br /> <br />By signing this renewal application, applicant certifies that there hos been no change in ownership, <br />corporate officers, or partners. If changes have occurred during the past 12 months, complete in its entirety the <br />attached Tax C1eorance Information, then sign below. <br /> <br />Date: /f)-7.. () J <br />. <br /> <br />'~JI <br />:IIt/Uj"JU :1. :'5ttMtE' <br />N e (Print) <br /> <br />FOR OFFICE USE ONLY (Do not write below this line) <br /> <br />Report by Police Department <br />This is to certiJY that the applicant and the associates, named herein have not been convicted within the past five years of any <br />violation of federal, state or loca1law, ordinance provision, or other regulation relating to tobacco or tobacco products, ortobacco <br />related devices, or any felony within the last ten years. <br /> <br />Signature <br /> <br />Title <br />