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Tobacco Compliance Check Form <br />Please make corrections to the business information if needed. <br />Community: RAMSEY <br />Business Name: Coborn's #2033 — OU - <br />Address: 7900 Sunwood Dr NW <br />RAMSEY, MN 55303 <br />Business Type: <br />circle one: Convenience, Convenience/Gas, Gas, Drug/Pharmacy, Tobacco/Smoke shop, <br />Supermarket/Grocery, General Merchant, Liquor, Bar/Restaurant, Other) <br />Date: 08/14/26 Time: ( ( 5 <br />Buyer: <br />use 3 initials <br />Was Purchase attempted: <br />Yes <br />O No <br />Was sale made? <br />*Yes ONo <br />Age Sex <br />O 15 0 18 0 Female <br />O 16 O 19 9 Male <br />® 17 0 20 <br />If No, check reason: <br />O Does not sell tobacco <br />O After Business hours <br />O Other <br />Officer: Ln1 <br />use 3 initials <br />O Out of Business <br />O Unsatisfactory/unsafe conditions <br />O Not applicable <br />Was Age asked? Was ID requested? <br />OYes *No Yes ONo <br />Did the Officer view the transaction? <br />OYes ®'No <br />Type of Purchase: <br />O Self service <br />O Clerk assisted <br />O Vending machine - unlocked <br />O Vending machine - locked <br />Was ID shown? <br />® Yes O No <br />Type of Tobacco Product: Amount Spent:4 �"1 /7te <br />�Y � Cigarettes 4,4\On <br />O Smokeless <br />O Cigars <br />O Other (cigarette papers, lighter, etc.) <br />Clerk Information: ® Female 0 Male Approximate Age: 0 Under 18 years <br />® 18 and over <br />