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��r'�� � <br />� �. �� . ��.-. � � � <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651)792-7034 <br />Cigaret�e/Tobacco Products License Application <br />1�u�sinc�% N;�in�, � <br />;! •:� iri� �:� ;�i I� �rK55 <br />Business Phone <br />Ec��ail Address <br />Y I 1 ;L <br />, <br />�i�:� <br />� � �'ti' � �1�,� �' 1���� k�Tf �'-_� �F �.�: ai�-±� .�'���11 �J���� � <br />�r��.�� — � � � -G� �2 ��� <br />Person to Catztact in ftegard lo Business License: <br />� �I75C t� � i� � - �. �: <br />.{�i�i� �-, ���'�� I ��[i � 1��1 �, � , �� � ��� �� � i � <br />Phone ir:.' ) � �lG� �� -�� �� ��� <br />€1.�reUy aaF;}` E�iIC LIIG lOIIOtViQ�' I IL C:11C•tiJ i0� {�I�G �Ci!!1 � Cb�'rGBF, �.giw�.ing JcL� I, r��;�7 ��_, �r� �,<rtcliat� Juiic <br />3f1, �� r�•��, u: t�e Cic�r c I' Ros�k•illc, Ca�t�r � CRar�s-�p, 3ta� oi' h�fis�[�, <br />License Rea uired <br />Cigaret#elTobacca Products $100.00 <br />'['he u��lc�;��,r�d sl7pli�arit r�rakes t?� i� appfi�stion p�'sttant tr� �I] t�►� Ir�wt af ��5c Stfltc ��F r;�1711�5�t�i �nd ttgul�fion a� <br />tk7t C�nc:i ;�f il� �i �• 4f T��fiY 4 ilw may frvm aii:�� to l.iror prL�i:l�eyiricludi a�, h r:�ti•��y;;_ Srsr�ae �[�G.lt3�. <br />� � —, <br />Signature - <br />,� <br />Date � � � _� � <br />If completed license should he mailed somewhere other than the business address, please advise. <br />