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�1 � <br />� �'��� � _ „ <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7032 <br />Off-Sale 3.2 Malt Liquor License Application <br />Business Name �� � � 1�'�ti � �, � �.1�' t� r�t � r�. �'1 C � `'� ��_� t'.. �: � i , L � ; .. <br />Business Address '1 '? � �.�r' C�C� {..� r�-�"�� ti F.��' �•� �'� <br />f <br />��, r� {_ �' 't:�� f � c= �.� f�+ � �� I I �. <br />Business Phone <br />Per-son to Contact in Regard to Business License: <br />� <br />' �� t� <br />Name �`,• 4 �•� ► � �ti�:� �,�� t'. ; �'� 't`� �_ <br />Address _ _— <br />Phone �.� s. <br />Drivers License Number_ . <br />Social Security Number <br />U.S. Citizen? _ Yes No <br />Date of Birth _ <br />Naturalized?_ _ Yes No <br />If yes, date and place: _ <br />I hereby apply for the following license(s} for the term of one year, beginning January 1, ��'�� �, and ending <br />December 31, r r� ���� , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired <br />Off-Sale 3.2 Malt Liquor Beverage <br />� <br />$30.00 <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation as <br />the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue #176.182. <br />�~: _ r� � � <br />Signature � c�,��,, <br />- 5J <br />D$hc � �' - � � • � � �� <br />lf completed license should be mailed somewhere other than the business address, please advise. <br />For ��,�i�� use only: <br />Receipt # � � ' '� � � � ' � <br />m <br />