Laserfiche WebLink
Ver <br />Tobacco Hearing and Penalty Notice <br />Violation: Tobacco Sales to a Person Under Age 21 <br />First Violation <br />Second Violation <br />Third Violation <br />Licensed Location: 19262 EVANS ST NW <br />Date of Violation: June 18, 2024 <br />Complete the following information and submit by day, month, year. <br />I wish to request an administrative hearing. Staff will contact you to coordinate a hearing date <br />before the Elk River City Council. <br />I waive my right to an administrative hearing and am submitting the applicable penalty. <br />Number of Violations within 36-month period Administrative Penalty <br />First Violation 300 <br />Second Violation 600 <br />Third Violation 1,000 and license suspension for not less than <br />seven days as determined by the city. The city <br />may also revoke the license. <br />Options for submittal are as follows: <br />Email this form to irichter, and make payment at: https: /' /cio-ofclkriver.revtrak.net_' <br />Mail this form and a check payable to the Office of the City Clerk at 13065 Orono Parkway, Elk <br />River, MN 55330. <br />Signature } <br />j <br />r.i vywl <br />y <br />Print Name & Title <br />C9 <br />Date <br />Page 285 of 379