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����� � � <br />� ,._. � . �., � � � <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN SSll3 <br />(651)792-7034 <br />C�gare��e/Tvbacco Products License Application <br />Business Name <br />Business Address <br />r '� �� � a q.�� <br />�1�� -� �i���� <br />Business Phone {� ��� �f�� �' ��n7� <br />�mai1 Address <br />Person to Contact in•Regard to Eusiness License: <br />Name <br />�[��! <br />�aster� �'•o� 1n� . . <br />trr�e� 1�� 1�435 <br />Address ���c�� �� I�rfield. f4. 60015 <br />. �� r�v� ����I� I �F <br />Phone ��7131 �-�31 � <br />I hereby apply far the following license(s) far the term of one�year, beginning July 1, 2dDln , and ending June <br />30, ��p.7 , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required <br />Cigarette/Tobacco- Products <br />$100.00 <br />The undersigned applicant makes this application pursuant to ail the laws of the State of Minnesota and regulation as <br />the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue #176.i$2. <br />� � � � <br />��erlt� i�F]en Signature � ����' -�.� � • r-• - <br />Assistant Secretary ""��—� , � � � " � � � - - �"- <br />Date � ��� <br />If completed license should be mailed somewhere other than the business address, please advise. <br />