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��� <br />��,,,,�� 1 , �.. 1 1 _�J <br />��ty af Rose�iIle <br />�+ en�an�e Departm�nt, I.acens� D�visat�n <br />2660 Civic �ente� Drive, Roseviile, MN 55�13 <br />(6S1} 792-7Q34 <br />�i�a�°e�ie/�obacco Produtc�s ���ens� Appi�cat�on <br />Busi��ess Name <br />B�siness Addr�ss <br />B�sin�ss Pho��e <br />E�nail Address <br />� <br />:x _ .: _� . '%__� �.. <br />Person to Contact in RegcrNd ta Busrness Lrcense: <br />Na�e � �t,�,,����.,� � <br />Addr�ss <br />�ilO[1@ <br />� r. , p1 <br />. <br />. . .r"�e.e+ .^v._._ ...�.:_-..�- .�•, <br />� / a S.-� '^ � . <br />I j� I � ' +� <br />., _,,,,.-.� � . _.-. 1:.« :d_ _. .._. . — <br />�! �." �' , .. _ . <br />.:�. �.,�. � .�. <br />i • �, <br />I l�ereby apply for�lle fqllovring license(s} for the tenn of on� year, beginning July 1, �i(� , and ending <br />ftlil� ��, �� �� , in the Ciiy of Rosevilfe, Coui�ty af �Lamsey, Siate of Mir�nesata. <br />� zce�ase Rea�aared <br />Cigaret�e/Tobacco Praducts <br />Fee <br />$100.qQ <br />Ti�e undersi��-�ed appliea��t makes t�is appiication pursuant to all tlie laws of th�tate oFMinnesota and ragulation <br />as ihe CnunciE oftlie City ofRose�ille �ay fi°om ticne ta tzme pres zbe, inctud' g Mir►nesata Statue #176.182. <br />Signat�re <br />Da�e <br />�f ccsr�pteied 6ic�nse shauld be mai�d somewhere other than t�e business ad€��ess, ptease acivise. <br />