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<br /> <br />tervi{{e <br /> <br />utaf)[ished 1857 <br /> <br />RECE1Vi:D \ <br />NO\} 1 5 2000 . <br />. <:\t;:,,' \1880 Main Street . Centervi{{e/ M'JIf... 55038 <br />,;, ~,~'." . ~ <br /> <br />(651) 429-3232 . :Tal( (651) 429-8629 <br /> <br />NOV 1 3 20001 <br /> <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 at3CX)"{) 3'~ A(;1L- in the City of eifel L- M/}C-,.- <) <br />in the County of AvoKA , State of Minnesota, Residence Telephone: {{;';;1)J22- ,59/'1 HEREBY <br /> <br />MAKES APPLICATION FOR LICENSE to be issued to RICHARD DEFoE, RICHARD A DEFoE ENT. <br /> <br />INC. DBA WATERWORKS BEACH CLUB, INC., to sell tobacco products at retail at 7281 MAIN STREET, <br /> <br />Business Telephone: ~il)!L1i-32J3..- in the City ofCenterville, Anoka County, Minnesota for the term of one (1) <br /> <br />year beginning with the 1st day of January, 2001 , subject to the laws ofthe State of Minnesota and the ordinances <br /> <br />and regulations of said City of Centerville pertaining thereto, and herewith deposit $ 75.00 in payment of the fee <br /> <br />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: Itplv/O{J <br /> <br />-~- /j /' ~ <br /> <br />~/1):~"U !~ f . <br /> <br />Signature <br /> <br />KictlA-rd ~F?)e/ <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 and the Mil = = ;1l~, named herein have not been convicted within the past five years of any <br />violation of federal, state or 10calla~r.ainance1'Tovisi~n, or other r~gulation relating to tobacco or tobacco products, or <br />tobacco related devices, or any felF-Y within the last ten years. ./// ",/' d/ // ~ ' ./ <br />/ ~ t.. ~'--?~..../ r {/~/ /:;// <br />Police Departm t Sjgnature: ~~ ~ ".. .r ,.~ -1)itle: - /f( ? X ~ /lee <br />Date: /~ /;::7"6>0 / tJ 1/ <br />//1' <br />