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� , �►1 I <br />' � 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 />I3usiness Name �'1alg�e�ns�02002 <br />Business Address 1611 W. County Rd. "C" <br />Rose�ille, lrfld 55113 <br />Business Phone 651/636-9365 <br />Pe�son to Contact in Regard to Business License: <br />Nan�e Belinda DancY,, Tax Mana�Er <br />Address __� _ n__ Rnx 9n1 11r�rf iP� d._.._II,.,.._61�1 `� <br />Phone 847/914-5413 <br />I hereby apply for the following license(s) for the term of one year, beginning July 1, 2004 , and ending <br />7une 30, 2005 , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required Fee <br />Cigarette/Tobacco Products $100.00 <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 City of Roseville may from time to time preseribe, including Minnesota Statue #176.182. <br />Signature .r,u ���� i�'�(��'�'`, ` <br />Date 4/�9e/�2 04 ��y' T� ��� <br />If completed license should be mailed somewhere other than the business address, please advise. <br />.��, <br />1 ��� <br />�,.�1��i <br />