Business Lic. Refund JumpersDate
To The Honorable Mayor
and City council
Dubuque, Ia 52001
Dear Mayor and council Members:
I am attaching hereto Cigarette License No.
June 30, ~¥. I discontinued business on
expiring on
~o~3 and
respectfully request your Honorable Body to grant me a refund of
$ ~o f
Name
D/B/A
Address of Business
Federal Tax # or Social Security #
STATE OF IOWA
RETAIL
i rctt¢ ¢rmit
CityNumber
B 1264
In accordance with laws of the State of lowa, and the action of
the City Council of DUBUQUE Iowa
(or Board of Supervisors) (City or County)
Business Location Name:
Business LocationAddress: 2600 DODGE ST
DUBUQUE IA 52001
Type of Sales: OVER THE COUNTER Ownership Type:
Legal Owner Name:
Legal Ownei
JUMPERS SPORTS BAR A&ID GRILL, iNC.
CORPORATION
JEP~_Y _MET~-ICI~ · 1~I~ ANJDC)NI MF,RRICK
2600 DODGE ST
D2445
DUt31TQUF.. IA 52001
This permit is nontransferable, is effective from and after DECEMBER 02,, 20
automatically expires on June 30th, 20 03' unless previously revoked
, authorized to sell cigarettes at the business location address
above in the City of DUBUQUE
DUBUQUE
County of , Iowa.
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, thi&~ 02 day of DECEMBER.4'2'~)2~
CLERK
JEANNE F. SCHNEIDER
~264
White Copy - Permit Holder
Yellow Copy - City/County
7o-001 (4/00)