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� r:� � � <br />- ' � Ii I) <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7032 <br />Amusement Device License Application <br />Business Name __�� (_ �/ AEi'I Ti�i/l! M�illT L�� <br />Fu D.�i�u cKE'i2'S <br />Business Address a 7� o �J .$n,lE�,c..,,✓�. f�vF <br />i>uS�II/LLl�� �%N SS/I �J <br />Business Phone ___(oS/ - l 36 - 3��3 <br />Person 10 Contact in Regard to Business License: <br />Name <br />Address <br />Phone <br />Nf}-.��vr� C' �/i3�-x rr�..�l mt-a!r / a! �,.. �-��oa+�s� <br />�77 �'�lP,e�F ���!/f �EN5E�i ✓/C.t6� �L �D/0�+ <br />�30 -a3�—.�o2oa <br />I hereby apply for the following license(s) for the term of one year, beginning July 1, ��{ , and ending <br />June 30, �o �, in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired <br />Amusement Device <br />Fee uanti Totai <br />$15.00 ____�_ ,S D o <br />(per mschine) <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation <br />as the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue #176.182. <br />Signahue �( N-L.�- �i�LP�...�--�----+ �/�F.tlsF' /%%6.< <br />Date � - S—o `� <br />If completed license should be mailed somewhere other than the business address, please advise. <br />a <br />For o�ce use only: <br />Namco Cybertainment Igc. <br />877 Supreme Drive (-f�o�'� s) <br />Bensenville, IL 60]06 <br />Ph: 630-238-2200 <br />