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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 //X&- t-f L. �TJJ� �?�S2 I � �� ����• <br /> Business Address C&03 <br /> Business Phone <br /> Person to Contact in Regard to Business License: <br /> Name 4,,::wd�1 <br /> Address /�D,� !L/'i4 L/9 (l� U��' /-r'-� <br /> Phone �f1 3 -L�L�vG,� Date of Birth <br /> Drivers License Number <br /> T <br /> Social Security Number @M <br /> U.S. Citizen? NAY e s o Naturalized? G/ Yes No <br /> If yes, date and place: �y�p ��;9i�e'l�frQ• <br /> I hereby apply for the following license(s) for the term of one year, beginning July 1, / . / . 03 , and ending <br /> June 30, &o ity of Roseville, County of Ramsey, State of Minnesota.. <br /> License Rea wired 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 prescr' , ' cluding Minn sofa Statue#176.182. <br /> Signature <br /> Date 119 -12-d z , <br /> If completed license should be mailed somewhere other than the business address, please advise. <br /> For office use only <br />