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� �� <br />� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseviile, MN 55113 <br />(651) 792-7032 <br />Game Room License Application <br />Business Name j C,IV ,� r,.i (1 �� <br />Business Address ��9 �rJ � 4t/��lty R UG C� �'o� <br />'R�S evr � l� ► M!�l 55 I I� <br />Business Phone �Q��' �p a-g -`�9 5�0 <br />Person to Contact in Regard to Business License: <br />Name B17"10�1�1 TOvYtCi.� CJ,. <br />,, �,: , _ <br />, <br />Address IID�J� C Ut�,✓lty I�U�i i�. �` v; <br />, ._ <br />,; , ., _ <br />Phone �, �7„}�'S' °� ��j �n <br />, � .. <br />I hereby apply for the following licet�se(s) for�� of bne year, beginning July 1, �� and <br />ending June 30, p05 ; in the City ofRos�ville, County of Ramsey, State of Minnesota. <br />License Reauired F�g, <br />Gamc Room $175.00 <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and <br />regulation as the Council of the City of Roseville may from time to time prescribe, including Minnesota <br />Statue # 176.182. <br />Signature /�-4� I;�U[.�! <br />Date � 7"d� <br />If completed license should be mailed somewhere other than the business Address, please Advise. <br />For o�ce use only: <br />