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� i.; �►1 I <br />�'' ---� ' � Il Il <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7032 <br />Cigarette/Tobacco Products License Application <br />Business Name J <br />Business Address � � �l�i �A; �'✓ : �� �✓�_ <br />� <br />�P�vr �� <br />Business Phone � l' � " (/ 3 % '-�(�G �C� <br />Pe�son to Contact in Regard to Business License: <br />Name <br />Address <br />Phone <br />1 hereby apply for the following license(s) for the term of one year, beginning July 1, ZC�G� , and ending <br />June 30, 2 UG �, in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired <br />Cigarette/'Tobacco Products <br />Fee <br />5100.00 <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 Ciry of Roseville may from time to time prescribe, including Minnesota Statue #176.182. <br />Signature <br />Date <br />_�f,�`�/�, zo�� <br />If completed license should be mailed somewhere ot6er than the business address, please advise. <br />��e A s -e- <br />y? q,` r�j Co�l�� A' ���� SS <br />-�y,,�,, �s <br />