STATE OF IOWA



STATE OF IOWARETAILCIGARETTE/TOBACCO/NICOTINE/VAPOR PERMITCounty Number FORMTEXT ?????In accordance with laws of the state of Iowa, and the action of the Board of Supervisors of FORMTEXT ?????Iowa(County)Business Location Name: FORMTEXT ?????Business Location Address: FORMTEXT ????? FORMTEXT ?????Ownership Type: FORMTEXT ?????Legal Owner Name: FORMTEXT ?????Legal Owner Mailing Address: FORMTEXT ????? FORMTEXT ?????Type of Sales: FORMTEXT ?????Is hereby authorized to sell cigarettes, tobacco, nicotine and vapor productsat the business location address abovein the City of FORMTEXT ????? County of FORMTEXT ?????, Iowa.This permit is nontransferable, is effective from FORMTEXT ?????,20 FORMTEXT ?????andautomatically expires on June 30, 20 FORMTEXT ?????, unless suspended or revoked.In Testimony Whereof, I have caused the seal of the saidCountyto be hereunto affixed. Done at FORMTEXT ?????,in the State of Iowa, this FORMTEXT ?????day of FORMTEXT ?????,20 FORMTEXT ?????.Issued By:County AuditorThis copy to be posted by the retailer where the sale is to be made in plain view of the public. ................
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