or LLP / Individual Partnership Corporation LLC LLP / /
Facility
store Cigarettes / i.e. bar / /
IndustryTerm
gas station / gas liquor store / convenience-with gas / retail establishment / convenience store-no gas / drug store restaurant gas station tobacco store / gas grocery hotel/motel / tobacco products / retail permit / /
Movie
PARTNER(S) / /
Organization
Iowa Department of Revenue Web / IOWA DEPARTMENT OF PUBLIC HEALTH Name of Issuing City / / /
Position
store manager / OR CORPORATE OFFICIAL / City Clerk / corporate official / CITY CLERK/COUNTY AUDITOR / corporate president / local jurisdiction City Clerk / County Auditor / /
APPLICATION FOR IOWA RETAIL CIGARETTE / TOBACCO PERMIT For period _________________________ , 20 ____ through June 30, 20 ____ PLEASE TYPE OR PRINT LEGIBLY Please mail this completed application to your local jurisdictio