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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 /> Ronald L. Edmiston for <br /> Business Name Speedav 5uperaterica LLC dba Superatpzica # 4502 <br /> Business Address 2380 West Camty Rd. D <br /> Roseville, MV 55113 <br /> Business Phone 651-633-3848 <br /> Person to Contact in Regard to Business License: <br /> Name Sharon Stevens for Speedway Superanerica LLC <br /> Address P O Box 1580-Attrt License Dept.,Springfield, OH 45501 <br /> Phone 937`863"7191 Date of Birth NNOW <br /> Drivers License Number <br /> Social Security Number <br /> U.S. Citizen? X 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, begiiuiing��v'�;y � 2003 and ending <br /> 200 3 _, 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 dime prescribe,including Minnesota Statue #176.182. <br /> 5e.-07- <br /> Signature <br /> Edmiston, TreasLwier for y Superamrica LLC <br /> Date /0./01-V? <br /> If completed license should be mailed somewhere other than the business address, please advise. <br /> For office use only: <br />