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Business Name <br />Business Address <br />Business Phone <br />� �1 I <br />' / ' � /1 /I <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 />"*�► �D1�'' IC�;:u�� l �'�: .J:tuB: I .�, <br />��'. ; ��� �fi;��� <br />i�E,VIIIE, MV 55113-37�i <br />651-787-�/3�3 <br />Perso» ta Contact in Regard to Business License: <br />Name �� � � �Y �� � <br />Address <br />Phone <br />� • :�� :� «� . ��� ��� i r �a � � i � � :� <br />937-863-6473 <br />I hereby apply for the following license(s) for the term of one y�ar, beginning July 1, �04 , and ending <br />June 30, �5 , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired <br />Gasoline Station <br />Fee <br />$130.00 <br />The undersigned applicant makes this application pucsuant 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 Mitu�esota Statue #176.182. <br />S;g„a�e_,���da� License Coordinator <br />Date Q'4' QCV/�`f'- <br />7— <br />If completed Hcense should be mailed somewhere other than the business address, plestse advise. <br />For o�ce use only: <br />�•aa� � � i•a• � �� i � <br />� � :�� :� i�� ; �a• <br />`•` I!' la 1 1 Il� 1 :1 <br />