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On -Sale 12 Malt Liquor License Application <br />Business Name <br />Business Address <br />Business Phone <br />Ze <br />'f /.00 <br />�tr ti <br />Person 10 Contact in Regard to Business License: <br />Name N-h 1-;7; <br />i <br />Address ti_ �►- <br />Phone .� Date of Hirt' <br />Drivers License Nmnb%,. <br />Social Security Nininbpr <br />U.S. Citizen? ,- I Yes _ _ No Naturalized? Yes _ _ No <br />If yes, date and plaec <br />'' hereby apply f r the f - flowing license(s) for the terra of one year, beginning Jana ar�r 1 a r � � and ending <br />December 31 100 �r g <br />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 purse <br />the Council of the City of Roseville may from time to tim <br />S igna <br />Date <br />f Minnesota and regulation as <br />,ota Statue #176.1$2. <br />If completed license should be mailed somewhere other than the business address, please advise. <br />For office use only: <br />ReeeiPt ## <br />