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Business Name <br />Business Address <br />Business Ph�ne <br />g�,���� <br />� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7032 <br />Amusement Device License Application <br />Har Mar Mall <br />2100 North Snelling Avenue <br />Roseville MN 55113 <br />(651) 631-3952 <br />Pe,•son to Contact in Regard tv Business License: <br />Name <br />Address <br />Plione <br />Theisen Vendinc� Companv (Denise Matrious) <br />3800 Nicollet Avenue South Mpls. MN 55409 <br />(612) 827-5588 <br />I hereby app1�0 0 5he following license(s) for the term of one year, beginning July l, 2 0 0 4 , and ending <br />June 30, , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reuuired <br />Amusement Device <br />Fee uanti <br />$15.00 4 <br />(per macl�ine) <br />Total <br />.� �� <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 fmm time to time prescribe, including Minnesota Statue #176.182. <br />Signature • �°'�� � '�'��`�``''�' <br />Date Apri 1 15, 2004 <br />If completed liceuse should be mailed somewhere other than the business address, please advise. <br />For o�ce use only: <br />