Buisness License Refund_Four Mounds FoundationMay 28, 2014
ALCOHOLIC
BEVERAGES
DIVISION
State of Iowa
Four Mounds Foundation
4900 Peru Road
Dubuque, IA 52001
Terry E. Branstad Governor of Iowa
Kim Reynolds Lieutenant Governor
Stephen Larson Administrator ABD
RE: LICENSE / PERMIT No. LC0040843
Dear Licensee / Permittee:
Enclosed is a state warrant in the amount of $126.75 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 $105.63.
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
Date:
To The Honorable Mayor
and City Council
Dubuque, IA. 52001
Dear Mayor and Council Members:
I am hereby requesting a refund on LIQUOR LICENSE, License No. -
LC (7DY°59,..5,
issued on
and expiring
&/2_7/P-1 .1 discontinued
business on and respectfully request your Honorable Body to grant
me a refund of $
Respectfully Submitted,
ane
.673
Fr ,e 11'1 0•Af Ai' 0 Al Di1:77
D/B/A
Address of Business
7L6 G303
Federal Tax # or Social Security #
z /
MAIL CHECK TO:
97 o Pe/v /0-X •
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