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<br /> <br />ctervi[[e <br /> <br /> <br />(651) 429-3232 . :Ta/C (651) 429-8629 <br />Application No. <br /> <br />RENEWAL APPLICATION FOR LICENSE TO SELL <br />TOBACCO PRODUCTS AT RETAIL <br /> <br />The undersigned, residing at <br /> <br />in the City of <br /> <br />in the County of <br /> <br />, State of Minnesota, Residence Telephone: ( ) - <br /> <br />HEREBY <br /> <br />MAKES APPLICATION FOR LICENSE to be issued to BILL BISEK, KELLY'S KORNER INC. DBA <br /> <br />KELLY'S KORNER BAR, to sell tobacco products at retail at 7098 CENTERVILLE ROAD, Business Telephone: <br /> <br />rtSl )t.~3 - ~)'11 in the City ofCenterville, Anoka County, Minnesota for the term of one (1) year beginning with <br /> <br />the 1st day of January, 2001 , subject to the laws of the State of Minnesota and the ordinances and regulations of <br /> <br />said City ofCenterville 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 past 12 months, complete in its entirety the <br />attached Tax Clearance Information, then sign below. <br /> <br />Date: tJof 2 ) ~O <br />. <br /> <br /> <br />Signature <br />M/lrl-~ J~ ~I 'sr.-k. <br />Name (Print) <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 ~d %1- ;'\S~')I ;~, named herein have not been convicted within the past five years of any <br />violation of federal: state or local law, o~d~aHee-PfoVfslOn,--br other rlaJion relating to tObac.c..o. or t..Obacco products, or <br />tOb~CCO related deVIce.'. or any felon~o the last ten~. .. .,/ / / ____. /~ _:/ . _~' <br /> <br />POhceDepar~t .goatore: ~ 4j;Z. ~, .:, Ut--. .ytle: t:7#1f. fMCf <br />Date: 1 ~~ IIi> f t~ ;; <br />