HomeMy WebLinkAbout8.j. Cigarette License Application . • .
CITY OF ROSEMOUNT
EXECtTTIVE SUbIl�tARY FOR ACTION
CITY COUNGIL MEETING DATE: MAY 18, 1993
AGENDA ITEM: 1993 CIGAR:ETTE LICENSE AGENDA SECTI4N;
APPLICATION CONSENT '
PREPARED BY: LINDA JENTINK, ADM. SEC. AGENDA ��� �
� �
ATTACFII�IENTS: CIGARETTE LICENSE APPLICATIQN APFR D �B
The city has received an application to sell cigarettes at Tom' s Super
Value, 14635 South Rabert Trail, by Mr. John Miller, the new owner.
State required Business Tax Identification Number is pending; the Social
Seeurity Number of the applieant has been received and the $8 .00 prorated
permit fee has been paid.
I respeetfully request your approval af this license requested by Mr. John
Mi11er, Elk River, Minnesota, new owner of Tom� s Super Val.u, which will be
renamed to Miller' s Super Valu, effective May 24, 1993 .
RECOMMENDED ACTION:
Motion to approv� the application ta sell cigarettes in the City
of Rosemount for the reminder o� the 1993 year at Miller�s Super :Valu.
COUNCIL ACTION:
• i i
z�� o osemoun�
PHONE i612)423-4411 28T5-145th 5veflt West,Rasemount.Minnesota MAXflfl
FAX j612}423-5203 Maiiing Address: Edward B.MCMenomy
P.O.Box 510,Rosemount,Minnesota 5506&0510 COUNGfLMEMBERS
Sheila K}assen
APPLICATION FOR LICENSE TO SELL CIGARETTES AT RETATL �ames�wad�staats
Ha.ry wi��cox
Oehnis Wippermann
TO THE CITY COIINCIL OF THE CITY OF ROSEMOUNT' IN THE COUNTY OF ADMINISFRATOFI
Stephan Jitk
DAR4TA, STATE OF MINNESOTA:
The undersigned resident of the City of Elk River in the
County of Sherburne, State of Minnesota, HEREBY MARES APPLICATION
FOR LICENSE to be issued to John Miller
to sell cigarettes and cigarette pagers and wrappers at retail at
Miller' s Super Valu
14635 South Robert Trail Rosemount MN 55068
in the City of Rosemaunt in said county and state for the �erm of
one year, beginning with. the4first day of January, 1993 , subject
to the laws of the State of Minnesota and �he ordinances and
regulations of said City of Rosemount pertaining thereto, and
herewith deposit $5 . 00 in payment of the fee prorated for
May 24th thraugh December 31, 1993 .
Dated � ���� , 19 ��
`_ . ,
._. ...-��1t�1 ������ :,V' . lrct E1�#�' .
Name of Applicant Title
a
Si ature of Applicartt
PLEASE RETURN THIS APPLICATI4N ALONG WITH THE $8.Q0 FEE NO LATER
THEN Ma.y 1, 1993 . PLEASE MAKE CBECRS PAYABLE TO THE CiTY OF
ROSEMOITNT �NU RETURN TO T$E ATTENTION �F LINDA JENTTNR,
ADMINISTRATIVE SECRETARY. CONTACT LINDA JENTINK IF YOU HAVE ANY
4UESTIONS.
�ver�l�ings �oming �UG,� �osemourct��
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Fortn
SP:CI State of Minnesota '
License Appli�ant Information
Under Minnesota law{M.S.270.72),the agency issuing you this license ls required to provide to the Minnesota Commissionar
ot Revanue your Minnesota businsss tax ideniification number and the Social Security number of each license applieant.
Underthe Minnesota Gov�rnment Data Practices Act and the Federal Privacy Act af 1974,we must advise you that:
This information may be used to deny the issuance,renewal ortransier of your ticense H you owe the Minnesota
L3epartmenl oi Revenue deiinqueni ta�ces,penaltias,or interest;
• The licensing agency will supply it oniy io the Minnesota Department of Revenue. However,under the Federal
Exchange oi Iniormation Act.the�epartment of Revenue is aliowed to suppty ihis inlormation to the intemai
Revenue Service;
� Failing to supply this in#ormation may jecapardize or delay the issuance oi your ticense or processing your renewa!
aP�lication.
Piease till in the toitowing intormation and teturn this form atang wfth your appiication to ths agency issuing the ticense,
Do not return this iorrn to the DepaRment of Revenue.
Pl�as�prlr�f or typ�
-Name of ficense being a ied tor and Gcense number
���1t�. � _ !I C'� ���r�� fc S a.-� ref�r I
censing monry name o aty,counry,or state agency issumgTicense
... ._. .. . ... . _ . _ . . . . . _.. _
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cense�enewa te
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PersonaJ information:
pptrcan s asi name irst name a in�ua oc�a cunry num r
�����e.ti/ �1 '� 1� ��-7-(G� -�(c SS'
p ican2 s a ress
1�3'1 � �� r � . ���� �vi��te � ��
Business information (if applicable):
Bus'rness name
'� ���Y'�` Ct Ll.�
vsi essa ress ity tate iF oe
J �4+J�� �7. 9�C��'IP i�'1' �Gt c ( �f�� �O�-c,�'►�" �1�1.� �°�����
Mmnesota tax�denU6catwn nu ber Federat tax�denUl►eau number �,
'r i� t/'
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/f a Minnesota tax IdentJfcatlon number!s not�equtred,please explaln orr the reyerse slde vf thls form. �''
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