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����i'� -�1 °`'1 <br />�,�I� _..l —. J—J J <br />City �f Roseville <br />Finance Department, License Divisian <br />2660 Civic Center Drive, Roseville, MN 55� 13 <br />(651) 792-7436 <br />CigarettelTobacco Products License Application <br />Business Name _L��`1t,(� `�� j�.�� 2 � C�`� � �.. � , <br />Busi�lcss Address � 71 �P L��C I n�--�-�-n ��1 <br />.� <br />Bus.if�ess Phone � p � �D <br />Efl�ai] Address <br />Aeisora 1n Co�rtact in Reba�°d to Bt�sistess Lrcc�lase: <br />- - — - • — - - • n , <br />Na�ue <br />Address _ � <br />Phonc <br />I hereby apply for dtie fallawin� license(s} for the term af oF�e year, beginning luly f, , and ending June <br />30, , in the Ciry of Rosc<<ille, Cour�ty of Ra���sey, State of Miiinesota. <br />License lZequii•ed Fee <br />Cigarcue/Tobacca Products 51aQ.00 <br />T�ie undersigned applicant makes this applicatioi� pursuant to all tl�e laws of the 5tate. of Mii�ncsata and regulation as <br />the Coui�ci] of ihe City of Rase�i]lE »iay from time to time prescribe, includi�3g Mim�esota Stat,�ae #i 7.182. <br />Signature <br />Date d��C�yt /� <br />If co�npleted license sh��Eld i�e mailed somewl�ere ofher tfia�i tE�e business add�•ess, please advise. <br />