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<br />.. <br /> <br /> <br />,tervi[[e <br />1:stab{isked 1B57 <br /> <br />1880 :;v[ain Street _ Centervi{{eJ 9vf'}.{. 55038 <br />(651) 429-3232 _ :Fa;c (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 \ <:1 go fV\~\ ~ 'S T in the City of (JL~.Jrm\j \l.Ut..--. <br />in the County of ~~ , State of Minnesota, Residence Telephone: (bSl)~ (dt:'iJ?J HEREBY <br />MAKES APPLICATION FOR LICENSE to be issued to JOHN MAGILL, DBA CORNER EXPRESS, to sell <br />tobacco products at retail at 1990 MA1N STREET, Business Telephone: (chI )~-~~in the City of <br /> <br />Centerville, Anoka County, Minnesota for the term of one (1) year beginning with the 1st day of January, 2001 , <br /> <br />subject to the laws of the State of Minne~ota and the ordinances and regulations of said City of Centerville <br />\ <br />\ <br />pertaining thereto, and herewith deposit $75i.,{J0 in payment'9fthe fee therefore. <br />~ '. - <br /> <br />By signing this renewal application, \dpflicant cert;Ji~s that there has been no Ch~~~\ ownership, <br />corporate officers, or partners. If ~hanges h~ve tJ-fcurred ,!!!~inp the past 12 months, complete in itsfntirety the <br />attached Tax Clearance InformatlO~, then sIgn b'elzw. (--.'."-<\,..... J <br /> <br />Date-?trrr 1.9 w:D 'i---,- '.\ . I <br />\ Slgna~t€( .' <br /> <br /> <br />FOR OFFICE USE ONLY (Applicant do not write below this line) <br /> <br />POLICE DEPARTMENT <br /> <br />This is to certify that the applicant aRB tHB ag3oci~, named herein have not been convicted within the past five years of any <br />violation of federal, state or local law, ordinanc~~\)r other regulation relating to tobacco or tobacco products, or <br />tobacco related devices, or any felon~e last ten years. ,;7 <br /> <br />PoliceDepartm.4tt . nature: '.. '4#' // . ~ TItle: d~f M''';' <br />D~: ~~~U p <br /> <br />M~: I"ca{ 1?C<kd.: ed.~' ~4 - C4m '~ d Aloe ~ <br />A/~ /J7b..n /. r0,be //~~s.e.411e) ~~ ,.r"/ /. _~ <br />L C/ __ t/2t::h q" ..- ",J' / $ "j~ CJlJ <br />I <br />