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<br />~ <br /> <br />r <br />. <br /> <br />STATE OF MINNESOTA <br />COUNTY OF ANOKA <br /> <br />CITY OFCENTERVILLE <br />Appliedon No. . <br /> <br />RENEWAL APPLICATION FOR LICENSE TO SELL <br />TOBACCO PRODUCTS AT RETAIL <br /> <br />, <br /> <br />The undersigned, residing at ~ l.t> ~~ J)e... in the City of C.CtJr'UW\ \...U; <br /> <br /> <br />intheCountyof-AM}~ . StateofMinneso~ResidenceTelephone: (~)1~1..- 1SS'2- HEREBY <br /> <br />MAKES APPUCATIONFOR UCENSE to be issued. to TODD STEFFAN. DBA CORNER ExPRESS, to <br /> <br />sell tobacco productS at retail at 1990 MAIN STREET, Business Telephone: (It:b\)~ ~in the City oj <br /> <br /> <br />Centerville, A.nolra County, Minnesota for the term of one (1) year ~nni11g with the 1st tltq of JIl1IlUlI'.1, 2fJfJS. <br /> <br />subject to the laws of the State ofMinnesota and the ordinances and regulations of said City ofCentenille pertaining <br /> <br />thereto, and herewith deposit $75.tJ' in payment of the fee therefore. <br /> <br />By slgnlng t1ds renewal flJ'pliclltioll, tlpplicllld certifies t1uIt there IuIS been BO clumge in 0WIIeI'Ship, <br />corpOl'tlte officers, OI'pll1'l1u!r& If elumges 1uwe ocetm'etl"gthe pllSt 12 mollth, complete in its entret.1 the <br />tJtttIeheil Tu CletJmnee InfOl'llUltion, then sign 1Jelow. <br /> <br />Date: " \ , \ o&.\: <br /> <br />~~ <br />'1:0;0 S~ <br />Name (Print) <br /> <br />FOR O~CE USEOl'iLY (Do not write below this fine) <br /> <br />Report by Police Department <br />This is to cert.iJY that the applicant and the associates~ named herein have not been eonv:icted within the past five years of any <br />violation offederal..state or local law, ordinance provision, or otherregulatiOllre1atingto tobacco or tobacco products, ortobacr' <br />related devices, or any felony within the last ten years. . <br /> <br /> <br />~~ <br /> <br />TItle <br /> <br />'=Y~~~ <br />