application permit · E-4

Approval of Cigarette License Renewal – July 1, 2026 – Maverick, The Depot Express, Parkside Liquor, Fareway, Hometown Spirits, Casey’s General Stores, Kwik Star and Tiffin Iron Tap — E.4

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6/4/26, 9:26 AM License Administration Start Date : 01-Jul-2026 End Date : 30-Jun-2027 License Fee : 75.00 Types of Sales : Over the Counter Type of Establishment : Convenience store/gas station Types of Products Sold : Cigarettes, Tobacco, Vapor Products, Alternative Nicotine Products Do you intend to make retail sales to : Yes ultimate consumers? Do you have other permits issued under : No Iowa Code chapter 453A at this retail location? If yes, provide permit number(s) in the next step: Ownership Details Owner Position Single Line Address FABER, SCOTT Officer 6749 CARDIFF CT JOHNSTON LARSEN, ERIC Owner 4407 NW 5TH ST ANKENY IA 5 BEECH, DOUGLAS Owner 729 NE BROOK HAVEN DR AN CASEY'S GENERAL STORES, IN Company 1 SE CONVENIENCE BLVD ANK JOHNSON, BRIAN Officer 9129 NW 73RD CIR JOHNSTON JAMES, SAMUEL Owner 3204 NE AVERY DR ANKENY IA Suppliers List A list of suppliers for cigarettes, tobacco, alternative nicotine, and vapor products must be included with all retail tobacco permit applications. Applicants may submit this information Can I help? https://govconnect.iowa.gov/TAP/Licensing/_/#38 2/3

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Attached to agenda item: E-4 Approval of Cigarette License Renewal – July 1, 2026 – Maverick, The Depot Express,...

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