Laserfiche WebLink
1 "'` I <br />y�-- ' � Il Il <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 <br />Business Address _1��5 � • ��u,�./j y �%,� �-� <br />osc2'i c. Lr- � l�% it/ .�5�� 3 <br />Business Phone G✓/ -- � �/ ^ � ��5� <br />Person to Contact in Regard to Business License: <br />Name ��O,��i �.d�� i N c � <br />rI <br />LJO N S <br />��SGG3 <br />�" <br />Address _ �77 �4�/lE-7�E' �id� ��/5��✓i��.tc /� lvoiD�m <br />Phone (p �D -�.�� - �?� 4l� x�o� 7(0 <br />I hereby apply for the following license(s) for the term of one year, beginning July I, , and ending <br />June 30, , in the Ciry of Roseville, Counry of Ramsey, State of Minnesota. <br />License Reauired <br />Amusement Device <br />Fee uaati Total <br />$15.00 �� � Oa <br />(per machine) <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation <br />as the Council of tho City of Roseville may from time to time scribe, including Minnesota Statue # 176.182. <br />Signature �c-� e-��� .�iE �ii/St�" �2 <br />Date �7 r ��� � <br />If completed license should be mailed somewhere other than the business address, please advise. <br />L <br />For o�ce use only: . ��Namco Cybertainment Inc. <br />877 Supreme Drive ���.5'G 6 3� <br />Bensenville, IL 60106 <br />Attn: Doreen Collins <br />