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Business Name <br />Business Address <br />Business Phone <br />� ` R► � <br />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 />�.aa� � .a.. p. ��: .a., �. c . �, <br />•:� �.ti �� i •�� � � <br />•�:a � <br />. . �: : <br />Person to Contacl in Regard to Business License: <br />Name <br />Address <br />����4� �'..\��' �� ria��. '�r��;V�� � �; <br />� � :��. :� �s� : �a� ��� i r �� � � iu � :� <br />Phone ���`�� <br />I hereby apply for the following license(s) for the term of one year, b�ginning July l, �D�+ , and ending <br />June 30, �5 , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required <br />Gasoline Station <br />� <br />$130.00 <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 />S;�,a� ��� ����,� License Coordinator <br />Date QY' �c[�� �7" <br />If completed Hcense should be mailed somewhere other than the business address, please advise. <br />For o�ce use only: �y �D� � <br />P.O. E�(' 1580 L�� �T <br />�II�ID, Q�0 455�1 159D <br />