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Attachment A <br />Cit�7 of Rasevi7le <br />Financ� Department, T.,icense Divisior� <br />2660 Civic Center Drive, Roseville, MN 55113 <br />{G51) 49Q-2212 <br />Off-Sale 3.2 Malt Liquor License Application <br />BUSiness NaR�e Jj� � �� <br />�3usiness Address � �R � �f��. .�_ S�l��- ' ---�� -��.�--- <br />. � u t �� �. . M i� �--5 � 1_� _ <br />B��siness Phone � -�' � �' � � � � <br />Persorr to Cofitact rr� Regai°d to Busu�ress Lice�rs•e: <br />Name <br />Address <br />Phone <br />- RA��� a�. _ ���� <br />Drivers License Ntu3�ber <br />Date of Birih <br />Social Security Number <br />U.S. Citizen? 1/ Yes No Naturalized? �Yes <br />If yes, date and place• <br />No <br />,, <br />I l�ereby �p�ply for the fol}owing license(s) €or tl�e ierm of one year, beginning July �, 'Z.Q(� , and ending <br />June 30, �(�, in the City of Rose�Tille; County of Ran�sey; �tate of Minnesota. <br />License Required <br />Off-Sa}e 3.2 1�]a1i Liq�[or Bevera�e <br />Fee <br />$30.G0 <br />The undersigned applicant �»akes this a�plication pursuant to all tl�e �a��vs of t��e State of Minnesota and regulatian <br />as the Co�inci] of the City of Itoseville n�ay fi-om time to tin3e prescrib�, ii�eluding Mir�nesota Statue #176.182. <br />� <br />Signatttre � ��� � <br />Date � �� 1 'j I � C%G � ..__ <br />If completed license shouid be mailed some�r�here otlier th�n the business address, please advise. <br />For° offrce use o�aly: <br />Receipt # <br />�j <br />