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City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive Roseville, MN 5511 <br />(651) 792 -7034 <br />Cigarette/'I'obacco Products License Application <br />Business e : v-t v r,/&. Ve4c <br />Business Address { <br />Business phone <br />Email Address <br />Person to Contact in Regard io Business .license: <br />Name <br />Address <br />Phone <br />I hereby apply for the foi f owing i iccnse(s) fOr the term of one year, beginning Jul 1, 0 _ � <br />� Y -__ . � �d ending June <br />30} , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Rye iced <br />Fee <br />igarette/Tobacco Products S100.00 <br />The undersigned applicant makes this applications pursuant to all the laws of the State of Minnesota and regulat��� as <br />the Council of the City of Roseville may f'rOrn time to time prescribe, including Minnesota Statue # 176-182. <br />Signature <br />Date <br />If completed license should he mailed somewhere other than the business address please ease a dvise. <br />