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City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, A4N 55113 <br />{65X} 49U -22X2 <br />Cigarette /Tobacco Products License Application <br />mi <br />Business dame <br />Business Address "r-� �kZ5 <br />< j <br />Business Phone ) <br />Peiason to Contact ih Regard to Blcsh License: <br />Name <br />Address <br />z � ';/-L <br />C'( ( <br />�x <br />Phone ` L <br />L <br />1 <br />Z hereby apply for the following license(s) for the terra of one <br />year, beginning July 1, 20} and end On200 i n the of Roseville,, Cou n t' of Ramsey, State Minnesota, g uxe 30, <br />License Required Fee <br />Cigarette/Tobacco Products $100.00 <br />The undersigned appIieant makes this application urs�iant to all the � • <br />p ass of the Mate of and regulation <br />as the Council of the City of Roseville may from thne to time rescri <br />p be,��n 1 g Minnesota statue 4176.182. <br />Signature <br />r T <br />Date 2-9',P <br />If completed license should be mailed somewhere other than the <br />business address, please advise. <br />C� � <br />