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Finance Department, in <br />2660 Civic Center Drive, Roseville, MN 5511 <br />(651) 490-2212 1 <br />Amusement Device License Application <br />Business Name .W-� '7 1 <br />Business Address <br />Business Phone <br />}person to Contact in Regard to Business License.` <br />Marne <br />Address <br />Phone <br />I hereby apply for the following license(s) for the term of one year, beginning July 1, z and ending <br />.Tune 30, , in the City of Roseville, Counter of Ramsey, Mate of Minnesota. <br />License Fie aired =e -Ouantity Total <br />Amusement Device $15.00 <br />(per machine) <br />The undersigned applicant makes this application pursuant to all the lays of the State of Minnesota and regulation <br />as the CounciI of the City of Roseville may from time to time prescribe, including Minnesota Statue # 176.182. <br />Signature <br />Date <br />If completed license should be mailed somewhere other than the business address, please advise. <br />For office use only: <br />