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Business Name <br />����� � <br />�� � J � ,� 1 � � <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55ll3 <br />(651)792-7034 <br />Ci�aret�e/Tobacca Products License Application <br />� � 3�� .. <br />��Iwl I:tiYo r�i:{I I L'SY �.• � 1� �� _ s• 1• �F� -.__��'r [�� �� L��� <br />Business Phone ! ��� � �.�.�J J � �� <br />Person to Contact in �rs�ur�r rU .5itrirr�at �rr.��as•�: <br />Name <br />- •-� . � y. �. <br />Address , r � �r� <br />Phone <br />I hereby apply for the following Iicense(5) for the term of one year, beginning July 1, , and ending June <br />30, , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required Eee <br />Ci�arette/Tobacco Products $10�.00 <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation as <br />the Council of the City of Roseville may from time to rime �e��r iL�c_ ir�t IUdi ��i� n�:�z,�i,� ��r,[�,� r� E r��.1 K' <br />Signature _ . _. _ �� <br />Date , . , �� �� � �. <br />If completed license should be mailed somewhere other than the business address, please advise. <br />