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ly <br />7Jpn ii/ Gi W A "A 5. rw lo I =nq� <br />rr <br />Finance Department, <br />0 <br />2660 Civic Center Drive, Roseville, MN 5511 <br />(651) 490-2212 <br />Gasoline Station License Applicatio i <br />41, <br />Business Name -mum a , cm III aEmtma # 4210 <br />Business Address 2172 AVE <br />M 5511.317 <br />Business Phone 651-4M-1.108 <br />Person to Contact in Regard to Business License; <br />Tame mom AIEQ2m fcr SLTEMERJa I <br />Address P.O, BCK 15EK) Ate. HE . , , 455a-158D <br />Phone 937 - 863 -6+73 <br />1 hereby apply for the following license(s) for the term of one year, beginning July 1, XM and ending <br />June 30, - �+ _ , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reguired <br />Gasoline Station <br />Fee <br />$130.00 <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 # 176.182. <br />Signature License Coordinator <br />Date <br />If completed license should be mailed somewhere other than the business address, please advise, <br />„o or Q0 �� �� SPEEDWAY SIMPER AMERICA LLC <br />P.O. BOX 1580 <br />SPRINGFIELD, OH 45501 <br />