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Busir�ess Name <br />Busit�ess Address <br />B�siness Pl�ane <br />Email Address <br />�`�I�„��_71� 1 1� <br />City of Rosev�lle <br />Finance Department, License Divis�on <br />2b60 Civic Center Drive, Raseville, Ml� S51 �.3 <br />(651) 792-7Q34 <br />�a�oline ��ation Licens� Appl�ca�ion <br />_� � . � , � f�, � , � ._.,.- ,� � � -� <br />� <br />�'erson to Cantact in Regar�d to Busines,s License: <br />Nan�e I 1��_�"1c ��� 6'l.� <br />AdcEress <br />��lOriB <br />� 1 Lc�.�.`�t � � � � <br />, I <br />r <br />_ _ ,.�M <br />' ''�_'_� ,. � .. . :��-s_�...��... <br />,. . -� r�' . . —�. � . � ,,.�t': _, <br />�. i � �� . ..� <br />- ,_ � <br />� , <br />9 p �. r+e. � ..._ ..._._._..._ __ ( __.._ <br />T hereby apply for the foll wing iieense(s} for #he term of one year, beginning .T�ly 1, �f�„�, and <br />ending June 30, � in the City af Roseville, County o#'Ra�nsey, State pf Min�Tesota. <br />�,icense_R_e__c� u i ared <br />Gasoline Statioi� <br />F�e <br />$130.00 <br />T11e undersigned applica��t makes tlais a�p]icatia�� pursuant to all the laws of f�e State of Minnesota and <br />re�;ulation as the Cot€nciI of the City a� Roser+illemay froin tirne to fiime prescribe, includi��g Tvlir�nesc�ta <br />Sta�ue # 176. i 82. <br />Signature <br />Date lJ <br />A. �re ins ec#ion is re uired before issua�ce pf a license. Please cail 65�792�-73�1 to set u an <br />[YiSD@C$1€}ll. <br />If completed iicense should be rnailed somewl�ere other tha�� ��e h�siness address, please advise, <br />