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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 old L. Ed1istm for S y SLPETawTlq LLC dba Superanerica # 4210 <br /> Business Address 2172 Lexinator, Ave. <br /> Roseville, NN 55113-4317 <br /> Business Phone 651-489-I 108 <br /> Person to Contact in Regard to Business License: <br /> Name Sharon Stevens for Speedway 5uperanerica LLC <br /> Address P 0 Box 1580-Attu license Dept., Springfield, OH 45501 <br /> Phone 937'663'7191 Date of Birth <br /> Drivers License Number 41110111M t <br /> Social Security Number �-- W <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, beginning 0y � 2003 and ending <br /> �rh0�,� 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 :ime cribe,inc ing Minnesota Statue #176.182. <br /> Signature • <br /> Edmiston, Treasurer for Speedway Superaner.ica UC <br /> Date /Q'�6�erz., <br /> If completed license should be mailed somewhere other than the business address, please advise. <br /> For offlCe use only: <br />