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� ���-, � �►.► i <br />.�' I ' ■ Il Il <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7032 <br />Gasoline Station License Application <br />BusinessName QSIS �Q��i�' ��jto <br />Business Address <br />vi 11e, M N 5511.3 <br />Business Phone h��''�9���,'rj <br />Pe�son to Contact in Regard to Business License: <br />Name <br />Address <br />Phone <br />I hereby apply fo the following license(s) for the term of one year, beginning July 1, Gw� , and ending <br />June 30, �_, in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired Fee <br />Gasoline Station $130.00 <br />The undersigned applicant makes this application pursuant to a ws of the State of Minnesota and regulation <br />as the Council of the City of Roseville may from time to time pr scri ' clu i g ' nesota Statue #176.182. <br />Signature <br />Date �'� ��� <br />If completed license should be mailed somewhere other than the business address, please advise. <br />%'� l�A� � CO�.G� <br />For o�ce use only: � <br />C�L��[/�/► `�" S '. <br />