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�►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 />Amusement Device License Application <br />Business Name �„��A' �N�S <br />Business Address `��� �p�,uy�/�O� �2 <br />e. <br />Business Phone (p�'' �Z 0' 1 � � � <br />Person to Contact in Regard to Business License: <br />Name �R �fl►J �� <br />Address <br />Phone <br />�j�� <br />I hereby apply�for the�#'�liowirig license(s)�for the term of one year, beginning July 1, Zbo , and ending <br />June 30, �pd S , in the City of Roseville, �ounty of Ramsey, State of Minnesota. <br />License Reauired <br />Amusement Device <br />Fee usnti Total <br />$is.00 5b � <br />(per machine) <br />The undersigned applicant makes this appiication pursuant to all the laws of the State of Minnesota and regulatian <br />as the Council of the City of Roseville may from time to time prescribe, includin Minnesota Statue #176.182. <br />Signature ^ <br />Date � _]�� <br />If completed license should be mailed somewhere other than the business address, please advise. <br />For o�ce use only: <br />