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O <br /> 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 <br /> r� ' { 1 , <br /> Business Address �Q�/ 4/ c���f�f A'j.7 <br /> ZI&e a zz� <br /> Business Phone '633 <br /> Person to Contact in Regard to Business License: <br /> Name <br /> Address <br /> Phone �D —�G�� 4'' ` Date of Birth <br /> Drivers License Number <br /> Social Security Number -11111111i11116 <br /> U.S. Citizen? N Yes o Naturalized? Yes No <br /> If yes, date and place: <br /> I hereby apply for the fo lowing license(s) for the term of one year, beginning January 1, e n d i n g <br /> December 3 11 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 pursuan the laws of the State � psota and regulation <br /> as the Council of the City of Roseville may from time to ' e pr rite,incl g e s�Statue#176.182. <br /> r � <br /> Signature � � 1�• !. t<.�---.-__ <br /> Date °';�` ''t��.-- <br /> If completed license should be mailed somewhere other than the business address, please advise. <br /> For office use only <br />