Refund Galaxies, Murray Cig PerTo The Honorable Mayor
and City Council
Dubuque, Ia 52001
Dear Mayor and Council Members:
t am attaching hereto Cigarette License No. F)OL]~$ expiring on
June 30, c~aa$. I discontinued business on ~i~ala~L and
respectfully request your Honorable Body to grant me a refund of
Name
D/B/A/
AddresS'of Business
Federal Tax # or Social Security #
Mail Check To:
Date
To The Honorable Mayor
and City Council
Dubuque, Ia 52001
Dear Mayor and Council Members:
I am attaching hereto Cigarette License No. ~og~$ expiring on
June 30, ~lm~3. I discontinued business on ~//~ } m~ and
respectfully request your Honorable Body to grant me a refund of
Name
D/B/A/
AddressUof Bus~ n~ss 6)
Federal Tax # or Social Security #
Mail Check To:
STATE OF IOWA
RETAIL
7 ¢rmit
CityNumber
004492
In accordance with l~.. s of the State of Iowa, and the action of
the City Council of DUBUQUE Iowa
(or Board of Supervisors) (City or County)
Business Location Name:
' B~siness LocationAddress:
GAL~ADCIES PUB
3203 JACKSON ST
DUBUQUE IA 52001
Ownership Type.'. CORPORATION
Type of Sales: OVER THE COUNTER
Legal Owner Name:
Legal Owner MailingAddress:
GALAXIES CORP. --- DENNIS MURRAY
3203 JACKSON ST
MINNEAPOLIS MN 55435
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 OO 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 Iowa, this 1S__Tday of JI~,,LY ,, 20 __
~ City M '
CLERK
JEANNE F. SCHNEDER
00
White Copy - Permit Holder
Yellow Copy - City/County
70-001 (4/00)
A 04492