Business Lic Refund Express DepDate J~$?~ a-~
To The Honorable Mayor
and City Council
Dubuque, Ia 52001
Dear Mayor and Council Members:
I am attaching hereto Cigarette License No. ~ /~z/ xpiring
June 30, £o~$ . I discontinued business on z/15/,)~
respectfully request your Honorable Body to grant me a "efund of
Name
D/B/AP
dd~ess of B~n~ss
Federal Tax
on
and
Mail Check To:
STATE OF IOWA
RETAIL
CityNumber
004507
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:
Business Location Address: 16.20 J.F.K. RD
DUBUQUE IA 52001
Type of Sales: OVER THE COUNTER Ownership Type:
Legal Owner Name: EXPRESS DEPOT 1NC.
LIQUOR DEPOT OF DUBUQUE
CORPORATION
Legal Owner MailingAddress:
204 E LAFAYETTE
MONTICELLO MO 63457
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, tfiis 1ST day of JU,LY,._., ~20
City M
CLERK
JEANNE F. SCHNEIDER
00¸
White Copy - Permit Holder
Yellow Copy - City/County
70-001 (4/00)
A 04507
DIRECT PAYMENT VOUCHER REQUEST
DATE 03/31/03
By: SUSAN WINTER
Vendor #: I T
Vendor Name LIQUOR DEPOT
& Address: C/O EXPRESS DEPOT, INC
P O BOX 57
MONTICELLO, MOi 63457
REFI ACTMTYI OBJECT I AMOUNT I INVOICE NUMBER
1 73100 42103 25.00 ! REFUND
2 i CIGARETTES
3
4 I
5 I
6 I
7
9
10
12 I
13
14
15
16
17 I
18
TOTAL $25.00 I
Description Of Good/Service Ordered:
CIGARETTE REFUND ON
LIQUOR DEPOT 1620 JFK RD CLO gED ON 2-15-03
Good/Service Received By:.
SUSAN WINTER
Department Authorization
Revised 4/2000
Payment Approved - Finance Director