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t3usii�css Name <br />Business Address <br />Bu�incss ?'�io»e <br />En�ai� address <br />���r'� _� _``1 <br />�� .1 ' . <br />Ci�y of Roseville <br />Fi�ianCe Department, Li�ense Divisian <br />2660 Civic Center Drive, Rose�ville, MN 55113 <br />{651 } 792-703b <br />Gas Pumps - Private Lieense Appiication <br />`. <br />�� �� � <br />,� C <br />.d <br />�`� �' ~� v � � /t <br />�e ,��e � /Z a S'��/ <br />� 3 1 '? g z�-� <br />Persvra to Co�zCac1 rrr Regard to Busines.r Lice��se: <br />Name <br />__ .. ,�-�_ <br />Address � �� � <br />Phonc � � � �j �' � / <br />2.� sen v� <br />�� Is � <br />--,�- � 4 <br />� �,�.SS 1 � <br />� t � � ����; � � �5�-���I� <br />[ hereby apply for tl�e foilowii�g licei�se(s) for thc term of one year, begini�ing Jttly 1, .�UU , ai�d endin� June <br />30, '�,�, ii� t��e Ciry aF Rosevi�le, Coui�ty of Ramsey, State of Mini�esota. <br />C�icense Re uired <br />Gas F'u»ips - Pri��a.tc c,�p,{�{� <br />The unde�sigtied applica�zt makes tl�is application pursuant to alf tl�e laws of t�e State of Mi�uicsota and regulation as <br />the Council af tl7e City af f�oseville ti�ay from time to time �3rescribe, i��cludi��g Min�7esota Statue #] 7b.182, <br />� <br />Sigi�ature <br />bate J ���' v 1 <br />�re ins ectian is re uired bef�re issuance of a iicense. Pleasc call 651-792-73 to set u an ins <br />�_ <br />��J�1�� � �j C <br />[f comple[ed license should be mailed somewl�ere othcr than the b�siness address, >>lease adeise. <br />