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�P <br />a3ml INI, ATA I <br />Finance Department License Division <br />C660 Civic Center Drive, Roseville, NIN 55113 <br />(651) 490-2212 <br />Cigarette/Tobacco Products License Appficatio4 <br />Business Name Walzreens #2002 <br />Business Address 1611 W County Road G <br />Business Phone 651-636-9365 <br />Person to Contact in Regard to Business License: <br />Name Belinda Fancy Tax Manager <br />Address PO Box 901 Deerfield, IL 60015 <br />Phone 847-914-5312 0 <br />I hereby apply for the following license(s) for the term of one year, beginning July 1, ?()nl and ending <br />June 3o _2004 - - - - --, in the City of Roseville, County of Ramsey, State of Minnesota. <br />AM 'Wr .F I <br />License Reg uired Fee <br />Cigarette/Tobacco, Products $100.00 <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation <br />as the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue #176.1825�, <br />Signature <br />Sj �ftj <br />Date <br />If completed license should be mailed somewhere other than the business address, please advise. <br />For office use only <br />41 <br />.0" <br />j <br />