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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 /> Off-Sale 3.2 Malt Liquor License Application <br /> Business Name <br /> Business Address ��(!� <br /> Business Phone <br /> Person to Contact in Regard to Business License: <br /> Name <br /> Address .SX�A �1/___ .J• GL'r ' ����J, ���J J���� <br /> Phone L( Date of Birth_ <br /> Drivers License Number � �2-4) /0 <br /> r <br /> Social Security Number � <br /> .S. Citizen? Nbl Yes o Naturalized?N / Yes o <br /> If yes, date and place: <br /> I hereby apply for the following license(s)for the term of one year,beginning July 1,2002, and ending December <br /> 3 1,2003, in the City of Roseville, County of Ramsey, State of Minnesota. <br /> License Required Fee <br /> Off-Sale 3.2 Malt Liquor Beverage $30.00 <br /> The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation <br /> as the Council of the City of Roseville may from time to time pre i , i !ud' �, �nnes Statue#176.182. <br /> Signature <br /> Date � <br /> If co leted license should be mailed somewhere other than the business address, please advise. <br /> Nip Ac./e. /."Y <br /> For office use only: �..� <br /> r <br />