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`�� -� <br />City of Rosevi![e <br />Finance DePartment, License Division <br />2660 Civic Center Drive, Raseville, MN 55113 <br />(651) '192-703f <br />Amusemen� Device License Application <br />Business Name <br />$usiness Address <br />�3usiness Phone <br />Emai€ Address <br />/d � ,L ``- �} �� `� �� � ?� L� <br />Person �o Conlacf rn Regard to Business License: <br />.r--�-- <br />Name /�� �"—_; f—p-L� `�' <br />T'� <br />Address � #� � � ���"� � ��i�� <br />Phone <br />I hereby apply far the following license(s) for the term of one year, beginning July ], , and <br />ending lune 3Q, , in the City of Rosevilie, County af Ramsey, State of Minnesota. <br />License Required Fee ua►�tit Tatai <br />Amusen-tenC De�ice <br />$ts.ao �---- _�r� <br />(per maehine) <br />"fhe undersigned applican[ makes this application pursuant to all the ]aws of the State of Ivlinnesota and <br />regulation as the CounciE of the City of k�oseville may &om time to time prescri5e, including Minnesata Statue <br />� 176.1. 82. <br />Signature � �� <br />Date / � <br />A tire Inspection is required before issuance of a license. Please caf[ b51-792-734� to set up an <br />inspection. <br />[f completed license should be mailed somewhere other than the business address, please advise. <br />