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Finance City of Roseville <br />Department, .: on <br />2660 Civic Center Drive, Roseville, MN 551131 <br />(651) 490-2212 <br />On-Sale 3.2 Malt Liquor License Application <br />Business Name c?IL 9 �.a/�. % �.,1 , <br />Business Address s L&qq* <br />V 41% 1 jP A� -C- S— <br />Business Phone � �`-� ��� 2-,r <br />Person to Contact in }regard to Business License: <br />Name <br />Bc VIk 9 Z—h A <br />Address <br />Phone- �, r —�.._ _ 1r -- Date of Birth -_ <br />Drivers License Number -%W.W 1 - , -.1-0 <br />Social Security Number <br />U . S . . . Naturalized? Yes No <br />If yes, date and place: <br />I hereby appl for the following license(s) for the term of one year, beg r r�� � 1, � _ _,, and ending J <br />30, , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required `e <br />On -Sale 3.2 Malt Liquor Beverage 100.0.E - <br />�{ 0 a <br />The undersigned applicant makes this application pursuant to all the lags of the State of Minnesota and regulation as <br />the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue 182. <br />ti <br />Signature <br />Date r <br />If completed license should be mailed somewhere other than the business address, please advise. <br />For office use only <br />Receipt # <br />