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� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MIV 55113 <br />(651) 792-7032 <br />Cigarette/Tobacco Products License Application <br />Business Name �� t` �''�41 4,� 1f��, {•����� w�r <br />Business Address � � �J' � ����; f(,� � � � ; `{.� ' ' I - j �y� <br />[ �.�� r 1 i' . L� ' I I �' •. _ p r <br />-�-�--^ a �- - 41 r I .__.._.. <br />' I r . <br />Business Phone ��,� ���� � x �, � . f � � � — — <br />� � <br />Person to Contact in Regard to Ba�siness License: <br />Name '�' �, � 4 ��� 4_`���� r' i I <br />1T1 1 <br />'h�� I�tL`55 - z. � i x 11 � I i J�i ��'�' 1~ � <br />4 � <br />Phone ���� �> ,-�-Z=,�'I— t-� �. f� 4� � —._ -- � �— <br />I hereby apply for the following license(s) for the term of one year, beginning July 1, 7�� ri , and ending <br />June 30, '?.�-; -�, in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired Eee <br />Cigarette/Tobacco Products $100.00 <br />The undersigned applicant malces 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 # 1'i6.182. <br />� A� <br />Signature ���' _ � <br />Date � <br />If completed license should be mailed somewhere other than the business address, please advise. <br />