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��� 1 _ r.. � � <br />� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7034 <br />Amusement Device License Application <br />r �x�,}� ,c ��I� � i_- + �y <br />�1�5i r.c53 �fIT�C _� , r �� � t-� � }'f�:{,,�,_r.'-F r'1�1� �•� � �� � l � F �-''�y�'�'t�{t��.-- <br />Business Address <br />Business Phone <br />�za�ail Address <br />�'���.. 1� <br />r� <br />�;�' / -�' L <br />�.._ �" <br />����� ����;..x� �� - fr �� � ���;�. � � ..� � �� � _ <br />Person to C'onlaet in Regard to Business License: <br />'_ �� �� <br />Name ,r � ��r'��� __-� ,r�,�'l`��,�� � � �5.� .r� �� � <br />Address � � � ��f����.�-� � _ �� .— :.�-� �#� �- r �.�'f��. <br />Phone �°�G��w � �3 � � ��� � �'�+�'� <br />I hereby apply for the fo�wing l�caxtse(s) for the term of one year, beginning 3uly 1, ��� and <br />ending June 30, �o- �' . in the City of Roseville, County of Ramsey, State of Mimlesota. <br />A.icense Required � n.'� 'F'�}�y� <br />Amusement Device $15.00 . �� ._ __,��'� <br />(per machine) <br />'f 3Yt lt1�.R3't +�d ��! i�ynE *h�kes � �ppli��Lioet Qafrg�teti� !� e�6 !h4 dA1�►�s OICI�IA SGiRE �F ��FH�R� ar�d <br />re+ae.ulatiat as !h� �'04 r�� I o!' FF;� {�ik�r � 3�� i3� rh fr�r5 ��n}c sa �3Kn.c prc�ctir�c, ir�;.fi�din� ����u189e,� Sca[i� <br />4l?G_l9?_ � <br />. �_.� <br />Signature � r <br />Date � � <br />A fire Insneetion is rea�r[refl before issuance of a license. Please call 651-792-7341 to set o� an <br />inspection. <br />If completed license should be mailed somewhere other than the business address, please advise. <br />