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Business Name <br />Business Address <br />Business Phone <br />Person to Ca <br />Name <br />Address <br />Phone <br />� ; .ry w� � <br />. ! � � � �� <br />City of Rosevitle <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 79Z-7032 <br />Gas Pumps - Private License Application <br />1 hereb apply for the following ticense(s) for the term of one year, beginning July l, 0���'* , and ending ]une <br />30, �,�, in the Ciry of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired Fee <br />Gas Pumps - Private $60.00 <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation as <br />the Council of the City of Roseville may from time to time proscribe, including Minnesota Statue # 176.182. <br />Signature � �`� <br />Date � � 13 — 0 � <br />If completed license should be mailed somewhere other than the business xddress, please advise. <br />For o�ce use only: <br />... ' . � . k �:iG. .. <br />::�� � • �..¢�� �� <br />pt # � <br />��Ly 5 <br />ll3 <br />