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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 /> . .. .......... ------ ----------------- ------- ------------ .................. <br /> Business Name "RA%Nd3oA.4Z) Fv�s � b <br /> Business Address <br /> rsS �I <br /> Business Phone �.��� `A%8 <br /> { <br /> Person to Contact in Regard to Business License: <br /> Name �'1A\ti► �3a� �o�.»� �`,N'. �.�R�1-i,q,,4. <br /> Address rt 4 5 I.nv� , <br /> Phone (9"7 lo$ Date of Birth <br /> Drivers License Number tJ i A <br /> SmiS1'Security Number <br /> U.S. Citizen? Yes No Naturalized? Yes No <br /> If yes, date and place: <br /> *OWN..�v� <br /> I hereby apply for the following license(s) for the term of one year, beginning and ending <br /> Ju xe-30, ".S , in the City of Roseville, County of Ramsey, State of Minnesota. <br /> � <br /> 3� <br /> i,icense 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 Roscville may from time to time prescribe, including Minnesota Statue # 176.182. <br /> Signature <br /> Date ?-no? _ <br /> If completed license should be mailed somewhere other than the business address, please advise. <br /> For offiCe use only: <br />