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2003-11-12 CC Packet
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2003-11-12 CC Packet
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2/9/2007 3:37:37 PM
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<br /> <br />ervir{e <br />'E.sta6{isfiet{ 1857 <br /> <br />1880 Main Street . CentervUfe,9If!J.L 55038 <br />(651) 429-3232 -1"a7C (651) 429-8629 <br /> <br />STATE OF MINNESOTA <br /> <br />CITY OF CENTERVILLE <br /> <br />COUNTY OF ANOKA <br /> <br />Appncation No. <br /> <br />RENEWAL APPLICATION FOR LICENSE TO SELL <br />TOBACCO PRODUCTS AT RETAIL <br /> <br />The undersigned, residing at .51/9.5 J .<;1 ~ S 1'"J Ai <br /> <br />in the city of fltI~o <br /> <br />in the County of IPIJ.S IJI,1)bt'tX State of Minnesota, Residence Telephone: <b!/)}/o1:- 7./1J1 <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: f6S1 )~- <br /> <br />_. <br /> <br />UJ.i in the City olCenterville, Anolra County, Mirmesota for the term of one (1) year beginning 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 ~ of <br /> <br />Centerville pertaining thereto, and herewith deposit $75.00 in payment of the fee therefore. <br /> <br />By signing this renewal application, applicant certifies that there has been no change in ownership, <br />corporate officers, or partners. If changes have occurred during the post 12 months, complete in its entirety the <br />attached Tax Clearance Information, then sign below. <br /> <br />Date: I/J-} 03 <br />. <br /> <br />~JI <br />1!~PA"'{f ;i. 5AUR <br />N e (Print) <br /> <br />FOR OFFICE USE ONLY (Do not write below this line) <br /> <br />Report by ponce Department ~ ~ ~ <br />This is to certi1Y that the applicant ~, named herein~not been convicted within the past five years of any <br />violation of federal, state or local law, ordinance provision, or other regulation relating to tobacco or tobacco products, ortobacco <br />re1aIl:d devicesr fGIolt, -'Iil~ill the last ten _ /' <br /> <br />Signature :-,..)- #~ !iIIe ~ -;( ;;;:t:e;, <br />IJ 1/ <br />
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