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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 1 by3 ccx.' <br /> Business Phone <br /> Person to Contact in Regard to Business License: <br /> Name <br /> Address <br /> Phone �a�Z��z�'- �a�td,�S Date of Birth <br /> Drivers License Number N <br /> Social Security Number <br /> U.S. Citizen? Yes No Naturalized? Yes No <br /> If yes, date and place: <br /> I hereby apply for the following license(s) for the term of one year, beginning July 1, , Za>j& e n d i n g <br /> June-30, c�.w�-� in the City of Roseville, County of Ramsey, State of Minnesota. <br /> License Repaired Fee <br /> Off-Sale 3.2 Malt Liquor Beverage 130-100 r <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 prescribe, including Minnesota Statue #1 76.182. <br /> Signature <br /> Date ZA� <br /> If completed license should be mailed somewhere other than the business address, please advise. <br /> For office use only: <br />