Business Lic Refund Dubuque Inn Liquor Refund
Date
;I/~/.Il/ ZtJoS
To The Honorable Mayor
and City council
Dubuque. Ia 52001
Dear Mayor and council Members:
I am attaching hereto Cigarette License No. lJi!;,&-DS7 expHlng on
June 30. f2S..... I discontinued business on Mar-Lk..ao. ~coS' and
respectful]y request your Honorable Body to grant me a refund of
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$ L_/
h l.{ 11 1.<& u €.-'~ rt ~orPt-T1 Otv
Name
~&t0~1LE L--
D/B/A
:3"131 7)~ e.-
Address of Busine s
L/Z -/0/ b 2{)(O
Federal Tax # or Social Security #
MAIL CHECK TO: \--. '-'
D etj~-LnJ N
l}f / -V01>GL- Sf:,
~.6~ 7/1 S-~
STATE OF IOWA
RETAIL
Clqft~/J!J!E fPE~Irr
City Number DBQ-05T
In accordance with laws of the state of Iowa, and the action of
the City Council of DUBUQUE Iowa
(City)
Business Location Name:
DUBUQUE INN CORPORATION
Business Location Address:
3434 DODGE 8T
DUBUQUE
Type of Sales: OVER THE COUNTER
Ownership Type: CORPORATION
Legal Owner Name:
DUBUQUE INN CORPORATION
Legal Owner Mailing Address:
3434 DODGE 8T
DUBUQUE, IA
Is hereby authorized to sell cigarettes at the business location address above
in the City of
DUBUQUE
County of
DUBUQUE
, Iowa.
JULY 1,
,20 04
and
This permit is nontransferable, is effective from
automatically expires on June 30, 2005
, 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 18T day of JUL Y
/) -__- I ,
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.