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i0i <br />Amusement Device License A li "cat on <br />�' <br />BusiniessName W4M ale AvbjuL-a <br />BusinessAddress e�7� ­7 tlo <br />Businiess Phonle <br />vyllqffwlm� <br />NW <br />Person to '" iont t in Rle,gard to Business License: <br />Name <br />Address <br />Phone <br />loop, <br />I <br />I hereby supply for the folliowing license(s) for the tertin off" one year, bleginninig July 1, lanid <br />eniding,Junie 310, in the City of Roseville, County of Ramsey, State of Minnesiota. <br />License Rieguired Fee Quantity Total <br />Amusle,ment, Delvilcle $15.00 '69 le) <br />(per machine) <br />The unidersigned applicant makes this application pursuant to ill the "laws of the State of Minnesota and <br />regulation as the Counicil of the City of Roseville may from time to time priescribe, inclining Minnesota Statue <br /># <br />1716.1' 2. <br />Signature <br />e <br />Date <br />A fire Inspection is required before issuance of a license. Please call 1651-7192-7,341 to slet u12 an <br />i n 's Vie c t i o, ln 0 <br />If com,pletied license slibolulid be mailed somewhere other than the buisiness, address, please advise, <br />-7 7 -Top <br />15844'�6,A) <br />//, � <br />