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I <br />A j,; <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, <br />(651) 490-2212 <br />m e <br />W0.1 <br />Business Name <br />13usiness Address <br />0—rA n .. ,, Po� <br />13 <br />Business Phone xa, <br />Person to Contact in }regard to Business License* <br />Name f) S- I <br />Address �� C � �_ � v- �`0 .� X16 � � .,(l �k� <br />Phone Ol ! � � � � � 3&ql <br />Y hereby apply for the following license(s) for the term of one year, beginning July 1, �2 h 6 � and ending <br />June 30, b� , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required 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 # 1 76.182, <br />Signature <br />Date <br />If completed license should be mailed somewhere other than the business address, please advise. <br />