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��� <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 />I— 4�t� 4� � <br />i�usi�cs5 [�ame _.����,L�.1'��3 1�..����- ,:.�._�`L� �r�=�.�,_ . �.�_��.. . . . . _._ <br />-� <br />Business Address ��.�L"� �_ _ �� �� � —.......—...— <br />�r � C' y �---- .��1 r..'� � �_� . <br />� � �•'���•---- <br />Business Phone �rL,�,` � �.�� j ---�: �� l� �,, — <br />Person to Contact r� Regard to Business License: <br />� <br />Namc .� �er�. _�__� �. �.�, <br />Ad�rcs� �� '� � �� �� � � �� _ r _ , .. . . . _. Y --- -� — <br />�nan� � � � � �- � � � � �k � <br />I hereby apply for the following license(s) for the tenn of one year, beginning July 1, �,�,�? �, and ending <br />June 30, -�� r,�t �—, in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required Eee <br />Cigarette/Tobacco Products $100.00 <br />The undersigned applicant malces this application pursuant to all t1�� ���+� �o f the State of Minnesota and regulation <br />as the Council of the City of Roseville may from time to time presc:ri� �r��+�drrig �� � ta Statue # 176,182. <br />Signature <br />� ' <br />Date � � ���� - �'� - — <br />If completed license should be mailed somewhere other than the business address, please advise. <br />