Refund - MadhattersDate
To The Honorable Mayor
and City Council
Dubuque, •Ia 52001
Dear Mayor and Council Members:
I am attaching hereto Cigarette License No.(0171_53 7 expiring on
June 30, 0,/ . I discontinued business on ,,,./.6181/6/ and
respectfully request your Honorable Body to grant me a refund of
//'(-9,// 27/d-e,;;<v4;
Address of Business
Federal Tax # or Social Security #
Mail Check To:
a
J•<-1--06 Luz._
STATE OF IOWA
RETAIL
City Number
004537
In accordance with laws of the State of Iowa, and the action of
the City Council of. DUBUQUE Iowa
(or Board of Superv£sors) (City or County)
Business LocatTon Name: MADHATTERS
BusinessLocationAddress: 1091 MAIN ST
DUBUQUE IA 52001
Type of Sale_s: OVER THE COUNTER Ownership Type:
Legal Owner Name:
Legal Owner Mailing Address:
STEVEN/MARCIA SCHIRM
1091MAINST
DUBUQUE IA 52001
CORPORATION
is hereby authorized to sell cigarettes at the business location address
above in the City of DUBUQUE
DUBUQUE
County of , Iowa.
This permit is nontransferable, is effective from and after JULY 1, ,20 O0 and
automatically expires on June 30th, 20 01 , unless previously revoked
In Testimony Whereof, I have caused the seal of the said
County DUBUQUE
City to be hereunto affixed Done at
in the State of lowa, this ~ 1ST day of JULY ,20
City M-
CLERK
JEANNE F. SCHNEIDER
00
White Copy - Permit Holder
Yellow Copy - City/County
70-001 (4/00)
A 04537