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CITY OF ROSRVILLE, MINNESOTA <br /> APPLICATION FOR MISSA03 E1tAPY ESTXBL15 LICENSE <br /> N E W 'y <br /> RENEWAL <br /> LICENSE FEE $300 . 00 BACKGROUND CHECK FEE Pill . 0 <br /> Please complete, ia--AuRlig ►t. with typewriter or by printing in <br /> ink. If the application is by'a natural person, by such person; if <br /> by a corporation, by an officer thereof; if by a partnership, by <br /> olie of the partners; if by an unincorporated association, by the <br /> manager or managing officer thereof. <br /> 1. Name of Applicant (name of individual, partnership, <br /> corporation, or &SSo iati0n) <br /> '11\ LA L4-r 0L6 1 . <br /> (If Individual) LAS'S' Flits PML MIDDLE NAME <br /> 2 . Name under which applicant will be doing business, business <br /> address, and telephone number: <br /> Full Name - - - - <br /> Business Address {� <br /> Business Telephone I- (0319___ <br /> 3, Type of Applicant: <br /> Individual Partnership Corporation <br /> Association Other <br /> 4 , A. If applicant is an ' 'du.4,,- <br /> i <br /> Name <br /> LAST FIRST V=Tj MIDDLE NANS <br /> Date of Birth <br /> Residence Address <br /> Residence Telephone <br /> Business Address <br /> Business Telephone <br />