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T- <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive -, Roseville, MN 55113 <br />(651) 79 -7034 <br />Amusement Device License Application <br />.... ....... . . <br />Business Marne t � <br />Business Address 1,3 141 r1f 6r, <br />Business Phone - -- 9O <br />Email Address <br />Person to Contact in Regui-d to Business License: <br />Name <br />Address <br />Phone <br />I hereby apply for the following license(s) for the term of one yeas, beginning July 1, 1009 _ , and <br />ending June 30, , in the City of .Roseville, County of Ramsey, State of Minnesota, <br />License - Required Fee Quantity Total <br />Amusement Device ``ff� <br />(per mach -Inc) - <br />The undersigned applicant makes this application Pursuant to all the laws of the State of Minnesota and' <br />regulation as the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue <br />#176.182. <br />Signature UX U6:�44 <br />Date l9 (O 6 r, - -- ... -- <br />A lire Inspection is required before issuance of a license. Please call .6 1- 792 -7341 to sett up an <br />inspection. <br />If completed license should be mailed somewhere ether than the business address, please advise. <br />