Cigarette License Refund_Kristina ChapmanTo The Honorable Mayor
and City Council
Dubuque, Ia 52001
Dear Mayor and Council Members:
I am attaching hereto Cigarette License No. 0 -- 6 J expiring on
June 30, a G '� I discontinued business on v 3 /- / and
respectfully request your Honorable Body to grant me a refund of
/
Name
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Address of Business
Federal Tax # or Social Security #
Date ' —/6
Mail Check To:
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Business Location Name: K -CHAP FOODS
STATE OF IOWA
RETAIL
CIC �E�lI7
In accordance with laws of the state of Iowa, and the action of
the City Council of DUBUQUE Iowa
(City)
Business Location Address: 1050 UNIVERSITY AVE
DUBUQUE, IA 52001
Type of Sales: OVER THE COUNTER Ownership Type: CORPORATION
Legal Owner Name: KRISTINA L. CHAPMAN
Legal Owner Mailing Address: 1035 WILSON
DUBUQUE IA 52001
City Number DBQ -059
Is hereby authorized to sell cigarettes at the business location address above
in the City of DUBUQUE County of DUBUQUE , Iowa.
This permit is nontransferable, is effective from JULY 1 .20 10 and
automatically expires on June 30, 2011 , unless suspended or revoked.
In Testimony Whereof, I have caused the seal of the said
City to be hereunto affixed. Done at DUBUQUE
in the State of Iowa, this 1ST day of J LY ,20 10
Issued By:
City Mayor or Clerk
This copy to be posted by the retailer where the sale is to be made in plain view of the public.