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<br /> <br />tervi[[e <br />'Esta6(ished 1857 <br /> <br />1880 ']v[ain Street . Centervi{{e, 'Jv{':7IL 55038 <br />(651) 429-3232 . :Tal'( (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 />Theundersigned,residingat ~ 0/{) ~~~ntheCityof ~ ~ <br />in the County of d~~, ' State of Minnesota, Residence Telephone: (C;;,5.':rLh~- D S7<57HEREBY <br />MAKES APPLICATION FOR LICENSE to be issued to PAUL MONTAIN, MOUNTAIN ENTERPRISES, INC. <br /> <br />DBA TRIO INN, to sell tobacco products at retail at 7082 CENTERVILLE ROAD, Business Telephone: ( <br />t,.{""1 <br />)~- ~q5pn the City ofCenterville, Anoka County, Minnesota for the term of one (1) year beginning with the <br /> <br />1st day of January, 2001 , subject to the laws ofthe 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: SjD? d-- (j/ ;)LJoo <br /> <br />/?JJ //! ~ <br />Signature <br />/;;U L /Yl CJ AJ /A- J A.J <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......J lh~ 8.~, named herein have not been convicted within the past five years of any <br />violation of federal, state or local law, ordinance .Irr.l)Jl.i~~ or other regulation relating to tobacco or tobacco products, or <br />tobacco related devices, or any fel~last ten years. ./:;/ <br /> <br />Police Departytenysignature: ~. P ff~ Title: C4 v( O/{C{ <br />Date: /1//5/dD ,/ ~ ! !//, <br />/ / r // <br />