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CITY OF ROSEVILLE <br />FINANCE DEPARTMENT, LICENSE DIVISION <br />2660 CIVIC CENTER DR., ROSEVILLE, MN 551l3 <br />(651) 490-2212 <br />VETERINARY HOSPITAL LICENSE APPLICATION <br />BUSINESS NAME 5'i F rl q�, ct 5 A N � M��- � a�� D b QS P� r� t- <br />BUSINESS ADDRESS 12 Z'1 L Il a Pt N r� u r� ,a v� w, <br />(LosEV►�-« ; r�-�� s's'►i3 <br />susnvESS PxorrE G S�- 2 y 1�- 3� �� <br />PERSON TU CONTACT IN REGARD TO BUSINESS LICENSE: <br />NAME `�AM n�� A. 7E,�/!� I vS 7_i) V f�'I . <br />FIRST MIDDLE - LAST <br />ADDRESS #�-Z � �- p R P�N7'�'bld q�/t �v. <br />��9 S E� t c,c � r✓_) MJ � 5 5" I 1 3 <br />PHONE ,:.. , <br />I hereby apply for the following license for the term `of one year, beginning July 1, tpdH , and ending <br />June 30, loo�, in the City of Roseville, County of Ramsey, State of Minnesota. <br />LICENSE REOUIRED• <br />FEE <br />VETERINARY HOSPITAL 580.00 <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and <br />regulations as the Council of the City of Roseville may from time to time prescribe, including Minnesota <br />Statue # 176.182. <br />Signature <br />Date �'%— lo -' C� `( <br />**If completed license should be mailed somewhere other than the business address, please advise. <br />Receipt # <br />