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Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792 -7036 <br />Cigarette/Tobacco Products License Application <br />Business Name <br />/2),34 1` D 5 ti M <br />Business Address � 6 D �2 <br />13A <br />Business Phone <br />Email Address � ���� � � H-01 e7-nj%4A- -y <br />Person to Contact in Regard to Business License: <br />Name N? ey- coo <br />Address <br />Phone <br />I hereby apply for the following license(s) for the term of one year, beginning Jay 1, p� r4 ,and ending June <br />30, in the City of Roseville, County of Ramsey, State of'Minnesota. <br />License Reguired Fee <br />Cigarette/Tobacco Products $200.00 <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation as <br />the Council of the City of Roseville may from time to time prescribe, including Minnesota. Statue ff 176.18 . <br />Signature <br />Date <br />If completed license should be mailed somewhere other than the business address, please advise. <br />