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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 /> On-Sale 3.2 Malt Liquor License Application <br /> Business Name 610 0 . V 4 T4-//j Nrw C ' <br /> Business Address a�� 7 S ;-t�klk_U r �r,J ,�'I V-& /l) <br /> LOse v, de N 5-5-//3 <br /> Business Phone ((0 ) <br /> Person to Contact in Regard to Business License: <br /> Name <br /> Address o�.5"��' t�-Ze�i��e�,J �`'� /V. �/(�.r/. N.,,V s s'i�3 <br /> Phone �5 � � 19�3�" ��� � Date of Birth <br /> Drivers License Number <br /> Social Security Number <br /> U.S. Citizen? N EX" Yes o Naturalized? Yes N o <br /> If yes, date and place: NFA us <br /> I hereby apply for the following license(s) for the term of one year, beginning January 1, 13 and ending <br /> December 3 1, o(k in the City of Roseville, County of Ramsey, State of Minnesota. <br /> License Reauired Fee <br /> On-Sale 3.2 Malt Liquor Beverage $100.00 <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 Stahie#176.182. <br /> Signature . <br /> Date <br /> If completed license should be mailed somewhere other than the business address, please advise. <br /> For office use only <br />