2002-01-09 CC Packet - Laserfiche WebLink

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1-------- ., .tervi[[e 'Estaflisfiecf 1&57 1880 :Main Street . Centerviffe, :M!J{ 5-'>038 (651) 429-3232 . :Fa.'( (651) 429-8629 CITY OF CENTERVILLE STATE OF MINNESOTA COUNTY OF ANOKA Application No. RENEWAL APPLICATION FOR LICENSE TO SELL TOBACCO PRODUCTS AT RETAIL Th d . d 'd' "Z 0. ,-" 0<> 1'"\ {\ ,- enn erslgne ,resl mgat _f~v ",,, n-., in the City of Cil'C-Je ?:/l ~ 5 in the County of ,State of Minnesota, Residence Telephone: (?b7) ?lilJ- ,)"i/';} HEREBY MAKES APPLICATION FOR LICENSE to be issued to RiCHARD DEFOE, RICHARD A DEFoE ENT. JNG. DBA WATERWORKS BEACH CLUB, INC., to sell tobacco products at retail at 728 1 MAIN SfREET, Business Telephone: ((,-;;\) 4~'l - 30 53 in the City of Centerville, Anoka County, Minnesota for the term of one (1) ear beginning with the 1st day of January, 2002 , subject to the laws of the State of Minnesota and the ordinances and regulations of said City of Centerville pertaining thereto, and herewith deposit $75.00 in payment ofthe fee therefore_ By signing this renewal application, applicant certif"res that there has been no change in ownership, corporate officers, or partners. If changes have occurred during the past 12 months, complete in its entirety the attached Tax Clearance Information, then sign below. , i / I,,{ /5/0; Date: .---.." /"1 ~ ({:JJ)9~ Signature KILL,ovJ A.~" I=oe Name (Print) FOR OFFICE USE ONLY (Do not write below this line) Report by Police Department This is to certifY that the applicant and the associates, named herein have not been convicted within the past five years of any violation offederal, state or local law, ordinance provision, or other regulation relating to tobacco or tobacco products, or tobacco ated devic '0> anfeltty W!\inKt:n years_ Signature , ~ U ________ Title Ow~e'"