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1��1�E <br />� <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 />�iusiness Name Wal.�reens#01804 <br />Business Address 1739 W. Lexington Ave. <br />Roseville, l�i 55113 <br />Business Phone 651/4$8-1962 <br />Person to Contact in Regard to �usi�:ess Lice�ue: <br />Name Belitxia . Dancy, Tax Mansgpx. <br />Address P.O. Box 901 Deerfield IL 60015 <br />Phone 847/914-5413 <br />1 hereby apply for the fallowing license(s) for the term of one year, beginning July 1, 200ta , and ending <br />June 30, 2005 , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired 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 prescribe, including Minnesota Statue #176.182. <br />Signature ,�'l_�a2/ ,��,r.r�r <br />Date Beli�a Dartcy, Tax Mattiager <br />�i/4./2(Xua <br />If completed license should be matled somewhere other than the business address, please advise. <br />