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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 �i� �� 7'NC CJ�hG¢.. �/¢�/NOS A.Plzk,'&}W <br /> Business Address a2�&11 121c V`01' c5 <br /> It205 ep at IYAJ <br /> Business Phone 6,s�_7 Vfl' ?cx��y <br /> Person to Contact in Regard to Business License: <br /> Name 0-7 <br /> Address a ��DD � 1//�C�p �i+��P .S� ��/�����P� /"/iU, ��dy <br /> Phone 7�3 r 2Ss'2 Date of Birth 0MOW <br /> Drivers License Number <br /> Social Security Number lw <br /> U.S. Citizen? 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 January 1, oP 0 Q,3 , and ending <br /> December 3 11 a-oo City of Roseville, County of Ramsey, State of Minnesota.. <br /> License Required 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 ' cluding Minnesota Statue #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 />