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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 tc� 7' F-S 4g.424 <br /> Business Address ���5 �Q�, PF F. 1 <br /> Business Phone �51� / (�oCg —O <br /> Person to Contact in Regard to Business License: <br /> .r <br /> Name ]EA.4 J4 Lt Al <br /> Address 3 7.30 'PQSEl.LxQN(-- 4 Al. w0uY"a <br /> Phone 763 /,4-6-7— 9�, .;�, �/ Date of Birth <br /> or <br /> Drivers License Number <br /> Social Security Number <br /> U.S. Citizen? N Yes o Naturalized? _Yes No <br /> If yes, date and place: ZI&I �,Lf�/f'�1i�.. <br /> I hereby apply for the following license(s) for the term of one year, beginning January 1,�and ending <br /> December 3 11 .� in the 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, including Minnesota Statue #176.182. <br /> Signature . ;- <br /> /7 <br /> Date <br /> If completed license should be mailed somewhere other than the business address, please advise. <br /> For office use only <br />