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� <br />����� <br />��i�+r �xf �os�r�ila� <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651)792-7034 <br />Amusement Device License Application <br />BusinessName �d � � �1��� ��� �� _ <br />� �I J � y ��� <br />Business Address _� � c3 / ����� � ,,, �t <br />Business Phone . ��.� � �'��'�" � ��.� ,������ i�� ���� ��� � <br />�t�a�1 Address <br />Person to Contact in Regard to Business License: <br />� lfTe �� r�� . . <br />_ � � � , � <br />Address <br />Phone — <br />�� <br />I hereby apply for the following license(s} for the term of one year, beginning July J, , and <br />ending June �4, , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired Eee �"a� '�oial <br />Amusement Device $15.00 �_ �� � <br />(per machir:e� <br />The undersigned applicant ma�es this application pursuant to al� the laws of the State of Minnesota and <br />regulation as the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue <br /># 17�6.182. <br />4ignar�r� _ �'?�--�Y� _ �� <br />�ate �— �� � � - .S �a � <br />A��'e Inspection is required before issuance of a license. Please call 651-792-7341 to set up an <br />inspection. <br />If completed license should be mailed somewhere other than the business address, please advise. <br />� <br />