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Finance Department, <br />0 0 <br />2660 Civic Center Drive, Rosevflle,, A4N 55113 <br />(651) 490-2212 <br />Gas Pumps � Private LO <br />icenise AppUcation <br />Business lame <br />Business Address � % `'f S � kx, &Le_� <br />Business Phone <br />Person to Contact in Regard to B inesR License: <br />ti Z ti's <br />Name <br />Address S k - - -- — - <br />Phone relo a <br />or <br />I hereby apply for the fallowing license(s) for the term of one gear, beginning July 1, } and wading <br />June 30, * , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required <br />Gas Pumps - Private <br />Fee <br />60.00 <br />The undersigned applicant des this application pursuant to all the laws of the State .ef ir�neseta -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 />Date T'Z t /.43 <br />If completed license should he mimed, somewhere other than the business address, please advise. <br />For ofce use only: <br />- ,� _ = ia'd l,j • -Pr •Y }'h^J�n7FC.-P� d.'-w�n ., - d <br />R!6 <br />K - <br />