Business License Refund_Dave's Downtown ConocoDate: / ! y
Honorable Mayor
And City Council Members
Dubuque, IA. 52001
Dear Mayor and Council Members:
am hereby requesting a refund on the Cigarette/Tobacco license number D13LL-O 60 /5
Number
held by �11L1� /),5bJ ch tud C 6 / c. This license was issued on
Legal Owners Name
7- /_ / y and expires on June 30, 20 %
Date Year
As of ?r 3 -/ 7 the business known as 94v s 0O a1.4.2 tel' &t/t' r d iV0(0 .?j'h c
Date Business Name
located at 5'0 G L DG' ft 5 j S f is no longer selling cigarettes
Business Address
or tobacco products that require a license. I am respectfully requesting a refund in the
amount of $ 75. OLD
Respectfully Submitted,
PAUi9/9J,9 in
Name (Print)
471- /Sa'Pto3
Federal Tax Number
Please mail the refund check to:
Name 91 lvz ,t/1470 s
Address
a l Yo i /1 c A tx o cal &,
roh' /PA,
5-.0a 00a
it
Il
CIO ftETTE / TO
STATE OF IOWA
Retail
ACCO/NICOTINE/VAP
r'C
PE
IP
IT
City Permit Number: DBQ-060-15
In accordance with laws of the state of Iowa, and the action of
the City Council of The City of Dubuque Iowa
Business Location Name:
Business Location Address:.
Type of Sales:
Dave's Downtown Conoco, Inc.
500 Locust St.
Dubuque, IA. 52001
Over the Counter Ownership Type: Corporation
Legal Owner Name:
Dave's Downtown Conoco, Inc.
Legal Owner Mailing Address: 500 Locust St.
Dubuque, IA. 52001
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, 2014
automatically expires on June 30, 2015
In testimony Whereof,I have caused the seal of the said
City to be hereunto affixed. Done at City of Dubuque,
in the State of Iowa, this 16 th Day of June , 2014
Issued by:
asir
City Clerk