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� , R1 I <br />" I ' �Il�l <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 />Business Name <br />Business Address <br />Business Phone <br />�'q������ ;V��:11�� � ���' i��:ya� � --" J <br />2785 Kl�� F�AM..Il�E AVE <br />I�VIIIE, MV 55113-1755 <br />651�i31 ]2k1 <br />Person to Contact in Regard to Business License: <br />Name 1i'IINl�S AT� fo�' �AY S�lP�liArIItICA IIC <br />Address <br />Phone <br />• � :�� :� ��a : ��• �•• i r i� � � i � � :� <br />937-863-6473 <br />I hereby apply for the following license(s) for the term of one year, beginning July 1, �J04 , and ending <br />June 30, �05 , in the City of Roseville, County of Ramsey, State of Minnesota. <br />Licenae Reauired <br />Gasoline Station <br />Fee <br />$130.00 <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesata and regulation <br />as the Council of the City of Roseville may fmm time to time prescribe, inctuding Minnesota Statue #176.182. <br />S;�a� ��,�,y,� ���„d�. License Coordinator <br />Date � /Q��� <br />If completed license should be msiled somewhere other than the business address, please advise. <br />For o�ee use onl : <br />�.5���'•\` �i'��•r'��tM� <br />• � :�� :� tt� : �a� <br />.,.. i r �a i� iu � :� <br />