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<br />, <br />I ,,/ <br /> <br /> <br />Q) <br /> <br />-, <br /> <br />STATE OF MINNESOTA <br /> <br />$;b;u <br />tJw,J YtIf- <br /> <br />APR 2 9 2002 <br /> <br />CITY OF CENTERVILLE <br /> <br />COUNTY OF ANOKA <br /> <br />App6catiOD No. <br /> <br />APPLICATION FOR LICENSE TO SELL <br />TOBACCO PRODUCTS AT RETAIL <br /> <br />The undersigned, residing at <br /> <br />''1<\'0 VV\.A:"" <<." <br /> <br />in the City of C~~\)j .....~G: <br /> <br />in the County of j\~c"""" , State of Minnesota, Residence Telephone: (V"l )llot - 1.... SSL HEREBY <br /> <br />MAKES APPLICATION FOR LICENSE to be issued to TODD STEFFEN. DBA CORNER ExPRESS, to <br /> <br />sell tobacco products at retail at 1990 MAIN STREET, Business Telephone: (Vii )..'fYL.- ().~ in the City of <br /> <br />Centerville, Anoka County, Minnesota for the term of one (1) year beginning with the 1st day of January, 2002 , <br /> <br />subject to the laws of the State of Minnesota and the ordinances and regulations of said City ofCentervillepertaining <br /> <br />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 offu:ers, or partners. If changes have occurred during the past 12 nwnths, complete in its entirety the <br />attached Tax Clearance Infornudion, then sign below. <br /> <br />1/1A, \01.- <br /> <br />Date: <br /> <br />.". ~ <br />Signa~ /t::> <br />'~y;) ~y~ <br />Name (Print) <br /> <br />FOR OFFICE USE ONLY (Do oot write below this 6oe) <br />j . <br />Report by Pollee Depa~ . ~f' 'lIVJIV" <br />This is !C certifY that th applican attEI-li:~ aslJeeiates, named herein have not been convicted within the past five years of any <br />violation offederal, state or I law, ordinance provision, or other regulation relating to tobacco or tobacco products, ortobaooo <br />related devices, or any felony within the last ten years <br /> <br />Signature Title 'Dv>"" ~ <br /> <br />~ 4~ ' <br />;tl~: r~ds eM- ~- ~IIV~ #5rPJ M>,=, ~I() ~ ~vl;1r <br />Cthz ~ JII~ '10 $6 fk~ ~ Auow Chfc~> ~ ~/rrz.- <br />