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<br /> <br />tervi[[e <br />Tstaflished 1857 <br /> <br />1880 Main Street . Centervi[[eJ %'JIL 55038 <br />(651) 429-3232 . ~a7( (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 <br /> <br />,-cy,be,(l S )j aJaR <br />" <br /> <br />in the City of <br /> <br />I~t/f 6;(JU/L t [. <br /> <br />in the County of fJ;1JOIG4 <br /> <br />, State of Minnesota, Residence Telephone: (6S/).!if22- 7dOJ <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: ( <br /> <br />/;SI )3d.f2- -.i/diin the City of Centerville, Anoka County, Minnesota for the term of one (1) year beginning with the <br /> <br />1st day of January, 2001 , subject to the laws of the State of Minnesota and the ordinances and regulations of said <br /> <br />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: /0/3/ DO <br />I" <br /> <br />~;; <br />Sign re <br />::t!::1U,v( [ J. ');;6 Vi" <br />Na e (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 and tI Uf ~ named herein have not been convicted within the past five years of any <br />violation of federal, state or local law, ordinan .., or other regulation relating to tobacco or tobacco products, or <br />tobacco related devices, or any felony... 1 in the last ten years. // / <br /> <br />Police Depart ent ignature: ,,}d'f!L'?7. '~--0itle: ~i 4; <br />Date: /!, ~ ..... <br />