2024 MHP/RCA Plan Review Application
2024 Kandiyohi County Vending Machine Application
2024 Special Event Camping Area Application
2024 Mobile Food Unit Application
2024 Kandiyohi County Tobacco Sales Application
2024 FPL Plan Review Application
2024 Special Event Food Stand Application and Guidelines
2024 Renville County Tobacco Sales Application
2024 Food, Pools and Lodging Application
2024 Mobile Food Unit Plan Review
Comments
Kandiyohi County Health And Human Services
2200 23rd Street NE, Suite 1080
Willmar, MN 56201
320-231-7800
2024 License Application for Tobacco Sales
New licensees must provide a floor plan/diagram for all areas within said location to be used for display and sale of tobacco. Please mail it with your check
Renewal New Owner
Establishment Information
Establishment Name:
Establishment Address:
City: State: AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY
Zip:
Telephone:
Owner Information
Owner Name:
Mailing Address:
Email:
Where should license information be sent: Licensee Address Establishment Address
Workers Compensation Information:
Pursuant to Minnesota Statutes 176.182 & 270C.72, the following applicable information is required of each license applicant:
Minnesota Tax ID Number:
Federal Tax ID Number:
Worker's Comp Policy Number:
Name of Worker's Compensation Insurance Company:
Address:
New licensees applying between October 1st and December 31st will pay a $150 licensee fee
Annual License Late Penalty:$.00
Make checks payable to: Kandiyohi County Health and Human Services
Mail to: Kandiyohi County Health and Human Services, 2200 23rd St. NE, Suite 1080, Willmar, MN 56201.
I consent to a check of law enforcement records to verify the statements on this application.
This is to certify that I am the individual who is the subject/business owner of the requested application.
This statement is to certify that all of the information in this application is true and correct and has been provided by the above named subject/business owner.
I certify that the information provided on this application is accurate and complete.
Online Application Completed
Submit and Pay Online Print and MailWith Payment