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�'�� -+I <br />,� ��r�� 1 , _ 1 _ � � <br />� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651)792-7034 <br />Ci�arettelTobacco Products License Application <br />Business iyatne ����: ���-• ��r�•�'ti �1'�� i�i� �� i� ti C 1{ 4.�I '�i ,Yi yti�.�,���1.-_� ti-4�-� �. r <br />, � �� r <br />+l��51'�f�2�+��5 I ��r + <br />��'.I.i:l:t:wti 15{i:� ti•�� I � .}`Jf�:.Ll�+ � 4� �L''� � U �•� ' � � V� � � �'L� � ��� Y� I �1� � I � _ <br />l3uslness Fhone __ �� � � �' 1 � � � ��� <br />, I <br />L'!i77i1 :'�d�i ��; . � �l � 4�5:� ti'.'� L' {.k: �� ' �'i�� � �� � ; L �1�.tiL? � .�t+��� <br />PeYSOn lo Cotatact in RegaYd to Business License.� <br />` p� r <br />�, i <br />Name ! 9� t�. 5���� �� t•'i ���' +!.. a <br />r; I <br />Address _� � I 4 `. �� ��i �—�� - e� �� �4i � ;i�' � ���� ��� • F:� j ] �f;� <br />rr - <br />Phone _-, ��� � � �" � � ��" +"��r � .�'_'� <br />I hereby apply far the following license(s) far 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 Reauired F�e <br />Cigarette/Tobacca Products $100.00 <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 time prescribe, including Minnesota Statue #175.182. <br />�� iI <br />Signature _��,� ���1-�,�,�-4,�� ���'�d��l�;li <br />L�iL� �i - �� ` .� �� - <br />If completed license sl�ouid be mailed somewhere other than the business address, please advise. <br />