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City of Roseville <br /> Finance Department, License Division <br /> 2660 Civic Center Drive, Roseville, MN 55113 <br /> (651) 490-2212 <br /> On Sale 3.2 Malt Liquor License Application <br /> Business Name �� 1 ��_ �/11 A Cir � �C• <br /> Business Address � � 1" � �,G E7 VF1 A q V�' <br /> oSF V111 Z7 PA f N <br /> Business Phone � '� (3 a <br /> Person to contact in regard to Business License: <br /> Name :.-r/c� C<.e e.,�9 <br /> First j Middle Last <br /> Address �� Y�" �t. �-c r-S �_<<^ Ln <br /> Phone Date of Birth <br /> Drivers License Number <br /> Social Security Number _ U.S Citizen? Yes No <br /> Naturalized? Yes No If yes, Date and place: <br /> I hereby apply for the following license for the term of one year, beginning July 1, 1999, and <br /> ending June 30,2000, in the City of Roseville, County of Ramsey, State of Minnesota. <br /> License Required, FS�. <br /> On Sale 3.2 Malt Liquor License $100.00 <br /> The undersigned applicant makes this application pursuant to all the laws of the State of <br /> Minnesota and regulations as the Council of the City of Roseville may from time to time <br /> prescribe, including Minnesota Statue # 176.182. <br /> Me Z) r-P 0 <br /> Signature <br /> ��J���1'� J� Date � <br /> If completed license should be mailed somewhere other than the business address, please <br /> advise. <br /> Receipt # <br />