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2004_0510_Packet
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2004_0510_Packet
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� <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 />Business Name ������ l �����'� � <br />Business Address �� �_ „ �� ���'���lf'.-��-� ��� <br />D�,s inrss P�,onc � �: J <br />� <br />_ �+�. ��� <br />i� <br />Person to Contact in Re�ard to Business License: <br />�'I <br />y <br />� � i i i� r" `� �r,� �� ��� ��'�� �-��.s �_� � � k_ �� <br />Address ��"..� _�_���}���J���'� '—�� �� <br />� _ . � � _ r�rk _ �.� � <br />Phone <br />� ����� <br />I hereby apply fo�he following license(s) for the terni of one year, beginning July 1, ���� �, and ending <br />June 30, �, in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required �g u� t� Clt � 'I' � a �� <br />Amusement Device � ��� � <br />$15.00 ��°� • <br />{per machine) <br />The undersigned applicant malces this application pursuant to s�: �fi� [:iws saf �1�� State of Minnesota and regulation <br />as the Council of the City of Roseville may from time to time � 4�4 '��, a�r�.iu�ting Minnesota Statue #176.182. <br />� `. <br />Signature ���� ���"�.� <br />Date _ �.:�� � <br />If completed license should be mailed somewhere other than the business address, please advise. <br />For officeuse o�ilv_ <br />— — , <br />I +.Y <br />� -' {'ti iy'�]"' :.,.� . . • •-_ •r <br />
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