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<br /> <br />1880 'Main Street ell Centervi[[e, 1'1[9\( 55038 <br />(6/r}I~-9!JflJ.1J1~~~ra-8629 <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 /tJ6'1-lot~ i...l in the City of Cot?;oJ 1!;9;19.d" <br />. <br /> <br />in the County of ;jt;O/~ , State of Minnesota, Residence Telephone: (P~J) 8,,&- ~~7';;' HEREBY <br /> <br />MAKES APPLICATION FOR LICENSE to be issued to BILL BISEK. KELLY'S KORNER INC. DBA <br /> <br />KELLY'S KORNER BAR, to sell tobacco products at retail at 7098 CENTERVlLLE ROAD, Business Telephone: <br /> <br />(~/)t;.'! -~ in the City ofCentervil/e, Anoka County, Minnesota for the term of one (1) year beginning with <br /> <br />the 1st day of January, 2003 , subject to the laws of the State of Minnesota and the ordinances and regulations of <br /> <br />aid City ofCenterville pertaining thereto, and herewith deposit $75.00 in payment of the fee therefore_ <br /> <br />By signing this renewal application, applicant certifies that there has been no change in ownership, <br />corporate officers, or partners. If changes h<<ve occurred during the past 12 months, complete in its entirety the <br />attached Tax Clearance Information, then sign below. <br /> <br />Date &--Jf / '/, c z <br /> <br />~a~ <br /> <br />Signature / <br /> <br />WrIIt1r>-v 731 :ulG <br />Name (Print) <br />).,r&,Iu; ~JJlflg:V"'f c../,ydC <br />FOR OFFICE USE ONLY (Do not write below this line) <br /> <br />*102. h.(~fO <br /> <br />f\~ q:$~oc.--i"~ /7~ <br /> <br />This is to certify that th applicant the associates, named herein have not bee;; convicted within the past five years of any <br />violation of federal, state or aw, ordinance provision, or other regulation relating to tobacco or tobacco products, or tobacco <br /> <br />::.:"\.~~:;p~~. T"" ~f ~/.< <br /> <br />~ 1'2-/3ZJ loa --YP'/P.frXo Sk:<Z yo ;'I//lVllvL <br />\~) PJ~ I' <br />/0/;11/0 '2-- - Tot3Ai/CD S4u= 1D /f1I/y(JrL <br /> <br />