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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�� � /� r � 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 ... ._. .. . ... . _ . _ . . . . . _.. _ _._ ._ _ .,� . . . . . _ _ .•. • - .- :- cense�enewa te . " �.I �c�t-� C-• �.n �Q cA .��- � I C1�'I� 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/' ; /f a Minnesota tax IdentJfcatlon number!s not�equtred,please explaln orr the reyerse slde vf thls form. �'' 1 1 l�.�t�(.,Q,,�, - I� � ture ioe � � t� � , � � i , � i i i i ,i � i � i i