Liquor License Refund_Rosewood Diner and Supper ClubTo The Honorable Mayor
and City Council
Dubuque, la. 52001
Dear Council Members:
I am hereby requesting a refund on BEER & LIQUOR COMBINATION LICENSE,
License No. Lc o 3 7 S ) .?issued on 3 - - .22 -- / 3 and
expiring 3 - Z /- 1 I . I discontinued business on
/o /o and respectfully request your Honorable
Body to grant me a refund of 0-II. Z- .
Respectfully Submitted,
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Name
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Address of Business
Federal Tax # or Social Security #
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Date:
- 22- - /
MAIL CHECK TO: D (Ri <pA1R ciL
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S 2 O U 2-
December 01, 2010
ALCOHOLIC
BEVERAGES
DIVISION
State of Iowa
Rosewood Diner & Supper Club LLC
3187 University Ave.
Dubuque, IA 52001
Dear Licensee / Permittee:
Licensing Section
Iowa Alcoholic Beverages Division
1918 SE Hulsizer
Ankeny, Iowa 50021
515.281.7400 (option 1)
Toll Free 866.469.2223 (option 1)
Enc.
cc: CITY CLERK / COUNTY AUDITOR
RE: LICENSE / PERMIT No. LC0037522
Chester J. Culver
Patty Judge
Stephen Larson
1918 SE Hulsizer Road Ankeny, Iowa 50021 -3941
Governor of Iowa
Lieutenant Governor
Administrator
Enclosed is a state warrant in the amount of $295.75 which was issued in payment of a
refund on your Class C Liquor License (LC) (Commercial).
Please apply to the CITY / COUNTY for their portion of the refund in the amount of $211.25
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A Division of the Department of Commerce PH 515.281.7400 FAx 515.281.7385 TOLL FREE 866.IowaABD WWW.Iowa ABD.com