Attached are the license application forms for Tobacco Sales and a copy of Minnetonka City Code 625 regarding this type of business.

Community Development Licensing 14600 Minnetonka Blvd. Minnetonka, MN 55345 Phone: (952) 939-8274 Fax: (952) 939-8244 Email: kleervig@eminnetonka.com To: From: Applicant for Tobacco Sales Kathy Leervig, Licensing Coordinator Attached are the license application forms for Tobacco Sales and a copy of Minnetonka City Code 625 regarding this type of business. Please complete the following attached forms and return to the above address: 1. Minnetonka Application Form 2. Minnesota Business Tax Identification form 3. Minnesota Workers Compensation Insurance 4. Minnesota License Application to Make Retail Sales of Cigarette form 5. License fee. Make checks payable to the City of Minnetonka. The 2018 Tobacco License fees is listed below: Tobacco per Establishment $235.00 Annually The licensing year is January 1 through December 31 and the licensing fee may not be prorated. An annual renewal notice will be sent approximately 30 days prior to the expiration date (to the address you designate on the application.) However, if the renewal forms do not reach you, it is your responsibility to contact the city to renew your license every year by December 31. Please read the attached documents and retain for your records: 1. The memo to: Holders of Tobacco Licenses, and also the Notice Regarding Possession of Tobacco Products ( employee form) for your use with employees. 2. Minnetonka Code of Ordinances; Section 625. Tobacco Sales 3. Minnesota Revenue: Sales of Cigarettes and Tobacco Products in Minnesota If you have any questions, please call me at (952) 939-8274.

Application for Tobacco Sales License COMMUNITY DEVELOPMENT-LIC 14600 MINNETONKA BLVD MINNETONKA, MN 55345 (952) 939-8274 Fax (952) 939-8244 Please enter a response on every line. Any incorrect information or an incomplete application is a violation of the City Ordinance and can result in denial of licensing and/or prosecution. ESTABLISHMENT Establishment/trade name Establishment address City, State, Zip Establishment phone number Email address Manager or agent of owner LICENSEE INFORMATION State Law: this must be a corporation or partnership name, or the individual s name that carries the tax liability. Licensee name Primary Officer Licensee address City, State, Zip Telephone Number Return license and send all notices & billing renewals to (all must be sent to the same address) Company Name Attention Address Telephone Number Email address FEE INFORMATION Tobacco License Annual Fee $235.00 Note: Proper signature required: if a corporation owns this establishment, an officer of the corporation must sign below; if a partnership, one of the partners; if an individual, the owner. I, (WE) THE UNDERSIGNED, HAVE COMPLIED WITH ALL REQUIREMENTS OF THE CITY CODE OF THE CITY OF MINNETONKA NECESSARY FOR OBTAINING THIS LICENSE. NOW, THEREFORE, I (WE) HEREBY MAKE APPLICATION TO OPERATE THE ABOVE NAMED ESTABLISHMENT SUBJECT TO ALL CONDITIONS AND PROVISIONS OF THESE ORDINANCES. Print name: Signature Date Print title:

MINNESOTA BUSINESS TAX IDENTIFICATION LAW Pursuant to Minnesota Statute 270C.72 (Tax Clearance; Issuance of Licenses), Subd.4, the licensing authority is required to provide, upon request of the Minnesota Commissioner of Revenue, either the applicant s Minnesota business tax identification number with the business name and address or the social security number of the primary officer, along with their complete name, home address, and home phone number. Under the Minnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of this information: 1. This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's withholding, or motor vehicle excise taxes. 2. Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement, the Department of Revenue may supply this information to the Internal Revenue Service. 3. Failure to supply this information may jeopardize or delay the processing of your license issuance or renewal application. NAME UNDER WHICH THE MN TAX ID IS FILED (licensee name) Type of license applying for: Tobacco Licensee: Address L City L State L Zip L Phone Establishment: Name Minnetonka License Number (completed by Minnetonka) Establishment: Address E City E State E Zip E Phone Minnesota Tax Identification Number Federal Tax Identification Number Signature: Date: INSTRUCTIONS FOR BOXES BELOW: 1. If all boxes above are completed, including both the Minnesota and Federal Tax numbers, no additional information is required by the MN Department of Revenue below. 2. However, if all boxes above are not completed, Minnesota law requires personal information about the primary owner or primary officer. In this case you must complete all boxes below, including the owner or primary officer s social security number, home address, and home phone. (NOTE: If the business and home address are the same, please check the box indicating this.) Applicant s (person s) name (LAST, first, middle initial) Social Security Number Home address Check if address is for both home & business Home City, State, Zip code Home Phone number Signature: Date:

Certificate of Compliance Minnesota Workers Compensation Law Minnesota Statutes, Section 176.182 requires every state and local licensing agency to withhold the issuance or renewal of a license or permit to operate a business or engage in any activity in Minnesota until the applicant presents acceptable evidence of compliance with the workers' compensation insurance coverage requirement of Minnesota Statutes, Chapter 176. The required workers compensation insurance information is the name of the insurance company, the policy number, and the dates of coverage, or the permit to self-insure. If the required information is not provided or is falsely stated, it shall result in a $2,000 penalty assessed against the applicant by the commissioner of the Department of Labor and Industry. A valid workers compensation policy must be kept in effect at all times by employers as required by law. BUSINESS NAME (Individual name only if no company name used) DBA (doing business as name local establishment name only if different than above) LICENSE OR PERMIT NO (if applicable) Completed by Minnetonka DBA/LOCAL BUSINESS ADDRESS (PO Box must include street address) CITY STATE ZIP CODE YOUR LICENSE OR CERTIFICATE WILL NOT BE ISSUED WITHOUT THE FOLLOWING INFORMATION. You must complete number 1, 2 or 3 below. NUMBER 1 COMPLETE THIS PORTION IF YOU ARE INSURED: INSURANCE COMPANY NAME (not the insurance agent) WORKERS COMPENSATION INSURANCE POLICY NO. EFFECTIVE DATE EXPIRATION DATE NUMBER 2 COMPLETE THIS PORTION IF YOU ARE SELF-INSURED: I have attached a copy of the permit to self-insure. NUMBER 3 COMPLETE THIS PORTION IF YOU ARE EXEMPT: I am not required to have workers compensation insurance coverage because: I have no employees. I have employees but they are not covered by the workers compensation law. (See Minn. Stat. 176.041 for a list of excluded employees.) Explain why your employees are not covered:. Other: ALL APPLICANTS COMPLETE THIS PORTION: I certify that the information provided on this form is accurate and complete. If I am signing on behalf of a business, I certify that I am authorized to sign on behalf of the business. APPLICANT SIGNATURE (mandatory) TITLE DATE NOTE: If your Workers Compensation policy is cancelled within the license or permit period, you must notify the agency who issued the license or permit by resubmitting this form. This material can be made available in different forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or TDD (651) 297-4198.

License Application to Make Retail Sales of Cigarette and Other Tobacco Products To be completed by applicant when applying for a license with a city or county. CT102 Applicant s Minnesota tax ID number The Minnesota tax ID must be issued in the same legal name of the licensee below. FOR MUNICIPAL USE ONLY License number Print or type Cigarettes/tobacco products will be sold (a separate license is required for each location or vending machine): Over counter Through vending machine Both Licensee s legal name Business trade name (doing business as) Period covered Date of issuance Federal employer ID number (FEIN) Daytime phone Complete address of business location (permit location) County Other phone number City State Zip code Fax number Mailing address (if different than business address) City State Zip code Email address Business information Type of legal organization (check one): Sole proprietor Minnesota corporation: Enter date of incorporation Partnership Out-of-state corporation: State of incorporation Other (describe) Are you registered to do business in Minnesota? Yes No Corporate officers or partners (attach a list if necessary) Name Title Address City State Zip code Name Title Address City State Zip code As a licensed tobacco products or cigarette retailer, I understand that: Statement of understanding Sign here 1. I can purchase cigarettes only from a Minnesota distributor or subjobber who holds a license with the Minnesota Department of Revenue. 2. I must obtain a tobacco products distributor license if I purchase untaxed tobacco products from an out-of-state company. 3. I may not sell cigarettes affixed with Minnesota Native American stamps unless my retail business is located on a reservation that has a tax agreement with the State of Minnesota. 4. I may not purchase from or exchange cigarettes or tobacco products with another retailer. 5. I must keep complete and legible cigarette and tobacco products invoices on the licensed premises, or make invoices available within one hour of request, for at least one year after the date of the purchase. 6. I know that the Minnesota Department of Revenue and/or law enforcement may conduct cigarette and tobacco inspections of the premises, including inspections of inventory, invoices and licenses, and I understand that a refusal to allow an inspection is grounds for revocation of my license. 7. I know that failure to comply with all requirements can result in criminal penalties, including the loss of cigarettes and tobacco products. Licensee signature Title Print name Date Daytime phone Licensing agent s signature Title Print name Date Daytime phone License applicant: Submit this form to the licensing authority along with the license application. Licensing authority: Mail or fax a copy of approved form to: Minnesota Revenue, Mail Station 3331, St. Paul, MN 55146-3331. (Rev. 8/12)

www.revenue.state.mn.us License Requirements for Retailers Sales of cigarettes and tobacco products in Minnesota Cigarette and Tobacco Products Taxes Fact Sheet 2 2 Fact Sheet Businesses that make retail sales of cigarettes and tobacco products to the public in Minnesota are required to have a special retailer s license. This fact sheet summarizes the requirements for obtaining a retailer s license and the responsibilities of a license holder. Retail licensing requirements Retail sellers of cigarettes and tobacco products in Minnesota must have a Minnesota Cigarette and Tobacco Product Retailer s license prior to purchasing or selling cigarettes or tobacco products. A separate license is required for each location or vending machine from which cigarettes or tobacco products are sold at retail. Licenses are issued and administered by the city, county or town in which the business is located. Responsibilities of license holders License display. You must conspicuously display your license at each retail location so that it is visible to the public, according to your licensing authority s rule. Records. You must keep complete legible records including invoices of all your cigarette and tobacco product purchases at each licensed location or at a central location for at least one year after the date of purchase. All invoices must be made available to Department of Revenue staff or law enforcement officers within one hour of request. Failure to produce records may result in your product being seized as contraband. Purchases. You must purchase your inventory of cigarettes and other tobacco products from a licensed Minnesota cigarette and/ or tobacco distributor or subjobber. If you make purchases of cigarettes or tobacco products from other sources, you are subject to civil and criminal penalties, and possible seizure of your cigarettes and tobacco products. Sales. You must only sell Minnesota-stamped cigarettes or tobacco products on which Minnesota tax has been paid. You are not allowed to sell cigarettes below cost, as determined by the Department of Commerce under the Minnesota Unfair Cigarette Sales Act (UCSA). In addition, it is illegal for you to sell cigarettes or tobacco products on which Minnesota tax has not been paid (e.g., items you purchased over the Internet, through Special Taxes Division Mail Station 3331 St. Paul, MN 55146-3331 Phone: 651-556-3035 Fax: 651-556-5236 cigarette.tobacco@state.mn.us (Rev. 11/15) mail order or brought in from another state). If you possess or make illegal sales of cigarettes or tobacco products, you are subject to civil and criminal penalties, and possible seizure of your cigarettes and tobacco products. Inspections. You must allow Department of Revenue staff without a search warrant to enter your place of business and inspect the premises, the records you are required to keep, and the packages of cigarettes, tobacco products, and vending devices on the premises. Cigarette. Any roll for smoking made wholly or in part of tobacco that weighs 4.5 pounds or less per thousand: (1) the wrapper or cover of which is made of paper or another substance or material except tobacco; or (2) wrapped in any substance containing tobacco, however labeled or named, which, because of its appearance, size, the type of tobacco used in the filler, or its packaging, pricing, marketing, or labeling, is likely to be offered to or purchased by consumers as a cigarette, as defined in clause (1), unless it is wrapped in whole tobacco leaf and does not have a cellulose acetate or other cigarette-like filter. Invoices. A detailed list of cigarettes and tobacco products purchased or sold in Minnesota. Each invoice must contain the following items: name of the seller name of the purchaser date of sale invoice number an itemized list of goods sold including the cigarette brand, number of cartons of each brand, unit price, and identification of tobacco products by name, quantity, and unit price any rebates, discounts, or other reductions Minnesota Unfair Cigarette Sales Act (UCSA). In Minnesota the practice of selling cigarettes at below wholesale or retail cost is an unfair and deceptive business practice and an unfair method of competition. UCSA is law enacted to protect the public by prohibiting sales of cigarettes at below wholesale or retail cost. Retailer. Any person who is engaged in Minnesota in the business of selling or offering to sell cigarettes and other tobacco products to consumers. Continued This fact sheet is intended to help you become more familiar with Minnesota tax laws and your rights and responsibilities under the laws. Nothing in this fact sheet supersedes, alters or otherwise changes any provisions of the tax law, administrative rules, court decisions or revenue notices. Alternative formats available upon request. Minnesota Revenue, License Requirements for Retailers 1

Tobacco products. Any product containing, made or derived from tobacco that is intended for human consumption, whether chewed, smoked, absorbed, dissolved, inhaled, snorted, sniffed or ingested by any other means. Tobacco products include cigars, cheroots, stogies, periques, granulated, plug cut, crimp cut, ready rubbed, and other smoking tobacco; snuff; snuff flour; cavendish; plug and twist tobacco; fine-cut and other chewing tobacco; shorts; refuse scraps, clippings, cuttings and sweepings of tobacco; e-cigarettes, e-juice, etc. The definition excludes any tobacco product that has been approved by the United States Food and Drug Administration and is being marketed and sold exclusively as a tobacco cessation or tobacco dependence product, or for any other medical purpose. Penalties Criminal penalties are in addition to any civil penalties that may apply. Unstamped cigarettes or untaxed tobacco products. It is illegal for any person, other than a licensed distributor or a consumer, to possess, receive, or transport unstamped cigarettes or untaxed tobacco products. It is presumed that any individual possessing more than 4,999 unstamped cigarettes or more than $350 worth of untaxed tobacco products is not a consumer. If you, directly or indirectly, purchase for resale cigarettes without the proper stamp affixed, your sales and use tax permit may be revoked. Sales of cigarette packages with Indian stamp. If you are not located on an Indian reservation, it is illegal for you to sell or offer to sell cigarette packages with Indian stamps. Sales after license revocation. If you sell cigarettes or tobacco products after your license has been revoked, you are guilty of a felony. Purchases from unlicensed sellers. It is illegal for you to purchase cigarettes or tobacco products from any person who is not a Minnesota licensed distributor or subjobber. If you purchase for resale from an unlicensed seller more than 20,000 cigarettes or $500 or more worth of tobacco products, your sales and use tax permit may be revoked. Anonymous tip line To report suspected Cigarette or Tobacco Tax violations: Email: tax.fraud@state.mn.us Phone: 651-297-5195 or 1-800-657-3500 Fax: 651-556-3105 Criminal penalties Penalty Unstamped cigarettes To possess, receive or transport: fewer than 5,000... Misdemeanor 5,000 or more, but fewer than 20,001... Gross misdemeanor more than 20,000... Felony Untaxed tobacco products To possess, receive or transport: up to $350 worth... Misdemeanor more than $350, but less than $1,400... Gross misdemeanor $1,400 or more... Felony Cigarettes with Indian stamp To sell or offer to sell: more than 200, but fewer than 5,000... Misdemeanor 5,000 or more, but fewer than 20,001... Gross misdemeanor more than 20,000... Felony Cigarette purchases from an unlicensed seller To purchase from an unlicensed seller: fewer than 5,000... Misdemeanor 5,000 or more, but fewer than 20,001... Gross misdemeanor more than 20,000... Felony Tobacco products purchases from an unlicensed seller To purchase from an unlicensed seller: up to $350 worth... Misdemeanor more than $350, but less than $1,400... Gross misdemeanor $1,400 or more... Felony Sales after license revocation To sell cigarettes or tobacco products after your license has been revoked... Felony Any other violation of state law, unless otherwise specified, is a misdemeanor. Criminal penalties are in addition to any civil penalties that may be imposed. Minnesota Revenue, License Requirements for Retailers 2

Community Development 14600 Minnetonka Boulevard Minnetonka, MN 55345 Telephone: (952) 939-8274 Fax: (952) 939-8244 TO: FROM: Holders of Tobacco Licenses Julie Wischnack, Community Development Director SUBJECT: Possession of Tobacco by People Under 18 As you are aware, the Minnetonka City Code prohibits anyone one under the age of 18 from having a tobacco product in his/her possession. As a result, a person under the age of 18 w ho is employed by a seller of tobacco products must not have those products in his/her possession at any time, whether it is for the purpose of storage, stocking, or sale. If a customer wishes to purchase a tobacco product, an employee under the age of 18 must request help from another employee who is over 18. We have prepared the attached form, which we are recommending that you use with your employees and retain for your records. If there is a violation of the ordinance and the employer can show that the employee had been provided this notice or one that is substantially similar to it, the consequences to the employer may be reduced. Accordingly, using this form may be to your benefit. If you have question about this law, please call Kathy Leervig at 952/939-8274 or myself at 952/939-8282. NOTE: THIS PAGE AND THE NEXT PAGE ARE BEING SENT TO YOU FOR YOUR BUSINESS USE -- DO NOT RETURN THEM TO US. WE SUGGEST YOU MAKE COPIES OF THE ATTACHED EMPLOYEE FORM AND, ONCE FILLED IN, RETAIN THEM IN YOUR RECORDS/FILE.

Notice Regarding Possession of Tobacco Products Under the City of Minnetonka ordinances, no one under the age of 18 may have any tobacco product in his/her possession. As a result, a person under the age of 18 who is employed by a seller of tobacco products must not have those products in his/her possession at any time, whether it is for the purpose of storage, stocking, or sale. If a customer wishes to purchase a tobacco product, an employee under the age of 18 must request help from another employee who is over 18. To be completed by employee: I acknowledge reading and receiving a copy of this notice. Date: Signature Print name

MINNETONKA CODE OF ORDINANCES; SECTION 625. TOBACCO SALES. 625.005. Definitions. The following words and terms when used in this section have the following meanings unless the context clearly indicates otherwise. 1. Movable place of business means a business whose physical location is not permanent or is capable of being moved or changed. 2. Person includes natural persons, partnerships, firms, corporations and associations. 3. Self-service merchandising means a method of displaying tobacco-related products so that they are accessible to the public without the intervention of an employee of the license. 4. Tobacco-related products means cigarette papers or pipes for smoking and any substance or item containing tobacco leaf, including but not limited to, cigarettes; cigars; pipe tobacco; snuff; fine cut or other chewing tobacco; cheroots; stogies; perique; granulated, plug cut, crimp cut, ready-rubbed, and other smoking tobacco; snuff flowers; cavendish; shorts; plug and twist tobaccos; dipping tobaccos; refuse scraps, clippings, cuttings, and sweepings of tobacco; and other kinds and forms of tobacco leaf prepared in such manner as to be suitable for chewing, sniffing, or smoking. 625.010. License Required. A person must not directly or indirectly keep for retail sale, sell at retail, dispense, or give away in a retail setting any tobacco related product at any place in the city, without first obtaining a license from the city. 625.015. Application and Issuance. Application for a license must be made to the community development director on a form supplied by the city. The application must state the full name of the applicant, the location of the building and the part intended to be used by the applicant under the license, the kind of business conducted at the location, and the other information as required by the application form. The community development director has the authority to determine whether or not a license will be issued. An applicant may appeal the director's decision to the city council by submitting a written request to the city clerk within 10 days after the decision. A license may be denied for the following reasons: 1. the applicant is under the ages of 18 years; 2. the applicant has been convicted within the past five years of any violation of a federal, state, or local law, ordinance provision, or other regulation relating to tobacco-related products; 3. the applicant has had a license to sell tobacco-related products revoked within the preceding twelve months of the date of application; 4. the applicant fails to provide any information required on the application, or provides false or misleading information; or 5. The applicant is prohibited by federal, state, or other local law, ordinance, or other regulation, from holding such a license. 625.020. Fees, Duration. The application must be accompanied by the required license fee specified in section 710. Licenses are valid for a one year period or part thereof and expire on December 31. 625.025. License Display. Every license must be kept conspicuously posted at the place for which the license is issued and must be exhibited to any person upon request. 625.030. Restrictions. No license may be issued to a person not of good moral character. No license may be issued for the sale of tobacco-related products at a movable place of business. A separate license is required for the sale of tobaccorelated products at each place of business. A license is not transferable from one person to another. 625.035. Mandatory Education. Each licensee must have at least one representative attend all mandatory tobacco license training seminars

conducted by the city. The representative need not be the same person each time but must hold a position of responsibility in either the ownership or management of the licensee. 625.040. Prohibited Sales. A person must not sell or give away any tobacco-related product to any person below the age of 18 years. A person must not sell, dispense, or give away any tobacco related product through the use of a vending machine or similar automated dispensing device. A person must not sell, dispense or give away cigarettes or smokeless tobacco through self-service merchandising, except in facilities where the retailer ensures that no person younger than 18 years of age is present, or permitted to enter, at any time. A person must not sell tobaccorelated products outside the location or area covered by a license. 625.045. Other Illegal Acts. Unless otherwise provided, the following acts are a violation of this section. 1. Illegal Possession. A person under 18 years of age must not have in his or her possession, or use any tobacco-related product. This subdivision does not apply to minor lawfully involved in a compliance check. 2. Illegal Procurement. A person under 18 years of age must not purchase or attempt to purchase or otherwise obtain any tobacco related product, and a person must not purchase or otherwise obtain such items on behalf of a minor. A person must not coerce or attempt to coerce a minor to illegally purchase or otherwise obtain or use any tobacco related product. This subdivision does not apply to minors lawfully involved in a compliance check. 3. False Identification. A person under 18 years of age must not attempt to disguise his or her true age by the use of a false form of identification, nor possess a false form of identification, whether the identification is that of another person or one on which the age of the person has been modified or tampered with to represent an age older than the actual age of the person. 625.050. Exceptions and Defenses. Nothing in this section prevents the providing of tobacco- related products to a minor as part of a lawfully recognized religious, spiritual, or cultural ceremony. It is an affirmative defense to a violation of this section for a person to have reasonably relied on proof of age as described by state law. 625.055. Violations: Administrative Penalties. Any person violating a provision of this section may be subject to the administrative enforcement program contained in section 1310.015 through 1310.050 of this code. In addition, upon finding that a licensee of any license granted pursuant to this section has failed to comply with any applicable statute, regulation or ordinance relating to the sale or use of tobacco-related products, the council may either revoke the license or suspend the license. 1. Licensees. Any licensee who has violated this section, or whose employee has violated this section, will be charged an administrative fine of at least $75.00 for a first violation of this section; at least $200.00 for a second offense at the same licensed premises within a 24-month period; and at least $250.00 for a third or subsequent offense at the same location within a 24-month period. In addition, after the third offense, the license will be suspended for not less than seven days. 2. Other Adults. Other adults who have violated this section will be charged an administrative fine of at least $50.00. 3. Minors. Minors found in unlawful possession of, or who unlawfully purchase or attempt to purchase, tobacco-related products, may be required to participate in a youth diversion, tobacco free education, or other alternative program selected by the chief of police. 4. Judicial Review. Any person aggrieved by a decision under paragraphs 1 or 2 above may have the decision reviewed in the district court in the same manner and procedure as provided in Minn. Stat. 462.361. 625.060. Violations: Criminal Penalties. Every person who commits or attempts to commit, conspires to commit or aids or abets in the commission of any act constituting a violation of this section, is guilty of a misdemeanor and every person who causes, coerces, permits or directs another to violate any of the provisions of this section is likewise guilty of a misdemeanor. Section 625.055 does not prohibit the city from seeking prosecution as a misdemeanor for any violation of this section.