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2004_0614_Packet
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2004_0614_Packet
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5/12/2014 1:11:39 PM
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12/14/2009 1:41:34 PM
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� <br />� <br />� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7032 <br />Gas Pumps -� Private License Application <br />r <br />i � � 1 �y <br />r�L� ii7css T� arr,e � �'I� ���•� i �.�.�. t ���.� ��,1�.1��ti '* � �L—•�S <br />"� �� <br />Business Address ,_���I ��� ���•-� 'J� <br />�� , ��ll� <br />���.�� �� l� �. .. _'-�'��� � <br />�U����� �n���t �{�.�^ � � �� � �� �� �� f�i.� <br />Person to Contact in Regard to Business License: <br />� <br />Name �� � ��'� � t, <br />.�Icldr�ss �• —�`'�. �'.� ... _ �-y _ ��.��.-s� <br />.� <br />Pho:�t �' � � � �- -? � ��4 � �'•-- <br />I hereby apply for the following license(s) for the term of one year, beginning July 1, �'tr'� , and ending June <br />30, �, in d�e Ciry of Roseville, Counry of Ramsey, State of Minnesota. <br />License Required Fee <br />Gas Pumps - Private $60.00 <br />The undersigned applicant makes this application pursuant [� �II [Iti� !$k'+� _ th� 51aic a� �inn�soC� �n� :��41��it�iti a� <br />the Council of the City of Roseville may from time to ti���e �,res�rih�, �� �i�� �+1 i������ S e� 1'��. I��. <br />Signature �'� �'� � �.� <br />Date ��� � � _ . <br />If completed license should be mailed somewhere other than the business address, please advise. <br />For office use onl,y: <br />Receipt # <br />
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