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<br />CITY OF CENTERVILLE <br />RENEWAL APPLICATION FOR LICENSE TO SELL <br />TOBACCO PRODUCTS AT RETAIL <br /> <br />Theundersigned,residingat .5ygs is) tJ ~. /11. intheCityof HI/60 <br /> <br />in the County of ~Jti4J/l;b fori. State of Minnesota, Residence Telephone: <lfil)-tJfl- 7#0 I HEREBY <br /> <br />MAKES APPLICATION FOR UCENSE to be issued to TERRY SAGER. SAHAWKOF MINNESOTA. INC. DBA <br /> <br />SAGER'S BAR-N-GRILlt to sell tobacco products at retail at 7098 CENTERVlLLE ROAD. Business Telephone: ( <br /> <br />j,tl ).Ml.-.l11L in the City aICen/ern/le, Anoka County, Minnesota for the term of ORe (1) year beginning with the <br /> <br />1st day 01 JaIUlary, 2008 , subject to the laws of the State of Minnesota and the ordinances and regulations of said <br /> <br />City ofCerrterville pertaining theretO. and herewith deposit $85.00 in payment of the fee therefore. <br /> <br />Report below details oftobacco law violations that have occurred within the last five years. (Dates, offenses, <br /> <br /> <br />fines or other penalties): (A/Lib -f't,BAtlo "'flit/JIlL ~~ h~J7,,:JoOJ h~1 ~ t'fO,OD <br /> <br />Report below details involving any license rejections or revocations: <br /> <br />By si,lIin, 'his 1'eftl'H1alapplictltioll, applic"", certifies that there Iuts been 110 c1umge ill OW1lel'$hip, <br />corp01'llle officers, or partners. If changes have occurred durin, ,he past 12 IIIDnths, complete in its elltirety the <br />attached TItt Clurance Injomudion, sig" below. <br /> <br />Date: 10 - /6" ~o7 <br />, <br /> <br /> <br />.ifli!Altl :r. .<;A6~ <br />N . ) <br /> <br />FOR OFFICE USE ONLY (Do not write below this line) <br /> <br />Report by Po6ee Depar1nlent <br />This is to certify that the applicant and the associates, named herein have not been convicted within the past five years of any <br />violation of federal, state or loca11aw, ordintp1l'.e provis~ or other regulation telating to tobacco or tobacco products, or tobaceo <br />re1ated devices, or any felony within the last ten years. <br />Signature Title <br />