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5 W-1 -0 M, ' - M, I MALITIlff My"Ir, <br />Business Nam ie SPE104AY 3JPM*MCA = cba SffM*MCA, # 41502 <br />Business Address 23M W Oa MY RD D PCSW=) W 155112-7584 <br />Business "'hone 651-633-3848 <br />Fmail Address <br />Person, to Conitact in, Regard to Business License: <br />Name <br />Address <br />I=- <br />I hereb anid <br />y apply for the fol�lowing license(s) for the term of one, year, beginning July 1, �M <br />enidi,nig June 301, in the City of Roseville, Count,)? lof Ramsey, State of Minnesota., <br />LI'cense Required' Feie <br />Gasoline Station $110.00 <br />'The undlersignield. aPplicant makes this application pursuant to, all the faws, oftlile State ofMinnesiota and <br />regul,atilon as, the Councill of the City of Roseville may fr rn inclulding Minnesota Statue <br />0, time to tirnie prescrible, <br />91716.18 2. <br />LICENSE COORDINATOR <br />Signature J)&M(4 axd", C, <br />Date U <br />A firle jns�peicflion iris required before issuance of a liciensle. Pleasie cal,! 651-7192-7,341 to, siet �un an <br />insp <br />If complieteld license shiould be mailed somewhere other than the business addriess, please aidvise. <br />SPEEDWAY SUPER AMERICA LLC <br />P10, Box 1580 <br />SPRAGIFIELD,, QH 4,5507 <br />