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Way Walgaa <br />MAYOR <br />Bill Blesener <br />COUNCIL <br />Rick Montour <br />John Reis <br />Michael McGraw <br />Shelly Boss <br />515 Little Canada Road Little Canada, MN 55117-1600 ADMINJSTRATOR <br />(651) 766 -4029 / FAX: (651) 766.4048 Joel R. Hanson <br />www.ci.little- canada. mn.us <br />APPLICATION FOR <br />CIGARETTE/TOBACCO PRODUCTS LICENSE <br />Please check appropriate license category for your business. <br />Tobacco Store License: <br />General Tobacco Sales & Display License: <br />Business Name: dt.Ne { S\C S`tic \\ \ r C <br />Business Address. it) ( \ \ \t CLi a ~ t cL <br />Business Phone: <br />Federal ID No: 'S - j 'b \'j it J-\ MN State ID No: \ l.o V \V2 <br />Licensee /Owner Information: <br />Name: �( n \LOS S <br />Address: <C ibv \ &x l t sl-ae n) V t "`" `JV7 Z \\ <br />Phone: <br />Please describe the nature of the business, including products sold, hours of operation, <br />etc.: <br />CS N,e Ck C\ Q\ v— Qom, -11-) \�C4-• Cc c, <br />eCs, INOV <br />(Over) <br />6 <br />