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1��� <br />� <br />Cify of �d.oseville <br />Finance Depar��nen�, License Divisic►n <br />2d60 Civ�c Center Drive, Rasevilie, MIoT 55�13 <br />{6S1) 792-7034 <br />C�ga�°e�te/Tobacco Products Liicen�e App�xca�ion <br />B��siness Nazane <br />Busines� Address <br />Business PY�one <br />os��r '�f� �� �' o:�� �`7-�..�..5`� <br />� � �� �1 �`t�c�� r{� � �C, �SC��1� r!C , �.1� ���y�� � <br />� �'�- ���':� ..�3�3 <br />Emaif Addres� ��` � <br />a <br />° • � �:H � `; . . •• , � <br />Person to Cantact in RegaYd ta I3usiness License: <br />Name �r�d�e � �� ��'��'�'� <br />Address � � �� �iv"t�� t� � ! � � �i�`� � a�.:SCOv°d 1 � � m��.`" �' �~���� <br />�'lione �•.�� � � �� �..�� �l � <br />I hereby apply for tl�e following lzcense{s) for ihe tez'zn of or�e year, begixining 7uly 1, �.���' , and e��ding <br />June 30, i7� irt tiae City af Roseville, County of Ramsey, State of Minnesota. <br />Lice�s� Re uired <br />Cigarette/Tpbacco Products <br />Fee <br />$100.00 <br />The undersig��ed app�icant �nakes ti�is applicatia�t �urs�aattt to aIi tl�e laws o�tl��itate of Miz�nesota ai�d regulatio�� <br />as tlle Coui�cil af the City ofRnseville �nay fro�n tiane to time prescribe, ine ding Mi►�ne ta Staiue #176.182. <br />Sigizature �`'� � <br />Date ��� � r � �M1� <br />Ti eompletied license si�oulr� be mai�ed sornewhere o�her than the business �ddre�s, pXease adv�se. <br />