Refund Beer & Cig Arby's Q MartTo The Honorable Mayor
and City Council
Dubuque, Ia. 52001
Dear Council Members:
I am hereby requesting a refund on BEER & LIQUOR COMBINATION LICENSE,
License No. C~, issued on ~-}~-~)~ and
expiring 4 - ~ --~ I discontinued business on
C~_ _~0 - II)~ and respectfully request you Honorable Body to
grant me a refund of 7~-~F~
Respectfully Submitted,
Name Fj CI i
D/B/A ' ~ -
Address of Business
Federal Tax # or Social Security
MAIL CHECK TO:
STATE OF IOWA
RETAIL
City Number
004480
In accordance with laws 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: ARBY'S Q-MART
10 MAIN ST
Business Location Address:
DUBUQUE IA 52001
OVER THE COUNTER
Type of Sales: Ownership Type:
Legal Owner Name: ARCON, INC.
CORPORATION
Legal owner MailingAddress:
645 32ND AVE S.W. SUITE 100
CEDAR RAPIDS, IA. 52404
is hereby authorized to sell cigarettes at the business location address
above in the City °fBUQU-EIJU DUBUQUE
County of.
This permit is nontransferable, is effective from and after JULY 1,
automatically expires on June 30th, 20 O1 , unless previously revoked
, Iowa.
,20 O0 and
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, J,~is 1ST day of JUL~Y~ ~ 20 __
CLERK
JEANNE F. SCHNEIDER
00
White Copy- Permit Holder
Yellow Copy - City/Couniy
70-001 (4/00)