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-� ��,;o --,� --� <br />'`"�,�!�- �..�f .f_ ,� <br />City of Roseville <br />Finaqce Department, L'[cense Division <br />2660 Civic Center Drive, Rasevi�le, MN 55113 <br />{65l) 792-7036 <br />Cigaretie/Tobacco Products License Application <br />ti <br />�USIlle55 'tval7le ,JJ� � y �,r �� C.� � D � <br />Busi�iess Address t 3 �,b�e � <br />Business Pltone ^ <br />Email Address <br />Person to Contact irz Regard lo Bassiness License: <br />Name <br />Address <br />Phone <br />0 <br />I hereby apply for the following license(s} for tlie term of o�ic year, begi�ini��g 3uly l, �C.J � , and e�idir►g Jutte <br />30, �'Q , in the City of E�oscville, County of Rarrtsey, State of Min��esota. <br />Lieense IZequired Fee <br />Cigarette/Tobacco �raducts $100.OD <br />The undersrgned appli.cant i�iakes dlis application pursuant ta a]€ the laws of t�ie State o�Minnesota and regulation as <br />the Couilcil of tl�e Ciry of Roseville may fron� time to time prescribe, including Mi:inesota Statue #176.182. <br />Signature � � �lt°/i,. <br />�ate �j � C� <br />[f completed license si�ou�cl be mailed some►vhere other than the business adc�ress, please advise. <br />� <br />