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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 /> BUS1rieSS Name Rpm1 d L. Edmiston for 1pv S=ramari ra I I f: rya .ri raramari ra # 497f1 <br /> Business Address 2295 Rice 5t. <br /> Roseville, NN 55113-3703 <br /> Business Phone 651-787-0733 <br /> Person to Contact in Regard to Business License: <br /> Name SheLnn Stevens for Speedway SupeT2rt12T].Ca LLC <br /> Address P D BOX 1580-Attu License Dept., Springfield, OH 45501 <br /> Phone 937.863-n 91 Date of Birth" <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, beginning)WV, � 2003 , and ending <br /> Pce0e 3�� in the City of Roseville, County of Ramsey, State of Minnesota. <br /> License Rwuired 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 prescribe, including Minnesota Statue # 176.182. <br /> S1g11ah1T'e ` � Y� r <br /> Fbnald V. Edmiston, Treasurer for Speedway Superanerica LLC <br /> Date /a-,- - d L <br /> If completed license should be mailed somewhere other than the business address, please advise. <br /> For office use only: <br />