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MDEPARTMENT' OF REVENUE License Application to Make Retail Sales of Cigarette and Other Tobacco Products To be completed by applicant when applying for a license with a city or county. ai CL O CL Am Applicant's Minnesota Tax ID Number rVn MUIVILA.rHL U,3U V!V!_f The Minnesota Tax ID must be issued in the same __ _.—.-________— License authority legal name of the licensee below. _._City Of Mounds View License Number _.._....._..........._....._...._...._..................... ..... . CT2024-009 Cigarettes/tobacco products will be sold (a separate license is required Period Covered for each location or vending machine): 01 /09/2024 - 12/31 /2024 ©Over Counter [,----]Through Machine g g L._...� Rath Date of issuance 01 /09/2024 ._I Licensee's Legal Name Federal Employer ID Number (FEIN) RASSEL WINE & SPIRITS INC 184-4192470 Business Trade Name (doing business as) Daytime Phone MERWIN LIQUORS MOUNDS VIEW I, (763) 432-1150 Complete Address of Business Location (permit location) County Other Phone Number 2577 Mounds View Blvd _ ramsey _ 1562.3225069 City State ZIP Code Fax Number Mounds View MN 55112 Mailing Address (if different than business address) City State ZIP Code Email Address 18087 66TH PL N Maple qrm MN 55311 BEVERAGEGROUP.ZAFIID@GMAIL..COM Type of legal organization (check one): F; Sole proprietor U Partnership e a Other (describe) E `o CID c v C N a 101 Minnesota corporation: Enter date of incorporation 12/20/2019 U Out-of-state corporation: State of incorporation Corporate officers or partners (attach a list if necessary) Are you registered to do business in Minnesota? Yes f_ i No Name Title km rassel zahid .__.. ____. _ .__president . ........... ._........ ......... .__ _ ....._.._. _. Address city-- - State ZIP Code 18087 66th pl Maple grove mn 55311 Name Title _.._ Address City State ZIP Code As a licensed tobacco products or cigarette retailer, I understand that: 1. 1 can purchase cigarettes and tobacco from a Minnesota distributor or subjobber who holds a license with the Minnesota Department of Revenue. The Cigarette and Tobacco Distributor List is on our website. Go to www.revenue.state.rnn.us and type Distributor List in the Search box. 2, 1 must obtain a tobacco products distributor license if I purchase untaxed tobacco products from an out-of-state company. 3. 1 may not sell cigarettes affixed with Minnesota Native American stamps unless my retail business is located on a reservation that has a tax agreement with the State of Minnesota. 4. 1 may not purchase from or exchange cigarettes or tobacco products with another retailer. 5. 1 must keep complete and legible cigarette and tobacco products invoices on the licensed premises, or make invoices available within one hour of request, for at least one year after the date of the purchase. 6. 1 know that the Minnesota Department of Revenue and/or law enforcement may conduct cigarette and tobacco inspections of the premises, including inspections of inventory, invoices and licenses, and I understand that a refusal to allow an inspection is grounds for revocation of my license. 7. 1 know that failure to comply with all requirements can result in criminal penalties, including the loss of cigarettes and tobacco products. Licensee Signature Title Print Name Date Daytime Phone president km rassel zahid 10/31/2023 5623225069 ._..__ _ - _..__.-- . - -_ ..._._ _ .. .-._.._ ....... __.. -_.. __.._. _..__ Licensing Agent's Signature Title Print Name Date Daytime Phone Executive Administrative Assistant Barb Benesch 763-717-4018 License applicant: Submit this form to the licensing authority along with the license application Licensing authority: Mail, email or fax to: Minnesota Revenue, Mail Station 3331, St. Paul, MN 55146-3331., Fax: 651-556-5236, Email: cigarette.tobacco@state.mn.us {Rrv. 7/19)