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2004_1025_Packet
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2004_1025_Packet
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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 />On-Sale 3.2 Malt Liquor License Application <br />a��� �; �� �'� �.`�'����� ���� � ,� � <br />��,a�� .�aa� ~ � <br />��� �. �r� �� �{� �'���� <br />Business Phone ` ���� 1 � �� " <br />Person to Contact in Regard to Business License: <br />Name � � / �'� �j <br />Address _, <br />i <br />Phone � <br />� ✓ - <br />Drivers License Number <br />Social Security Number <br />U.S. Citizen? . . {es No <br />. � <br />Date of Birth � � <br />Naturalized? Yas <br />If yes, date and place: <br />-----�---- <br />No <br />I hereby apply for the foll wing license(s) for the term of one year, beginning January 1, �i r�o #, and ending <br />December 31, +�� in the Ciry of Roseville, Counry of Ramsey, State of Minnesota. <br />License Required <br />On-Sale 3.2 Malt Liquor Beverage <br />Fee <br />$100.00 <br />The undersignedapplicant makes this application pursuant to all the laws of the State of Minnesota and regulation as <br />the Council of the Ciry of Roseville may from time to time prescribe, including Minnesota �i�rtpa �] �6.] ��. <br />z <br />Sr�� J <br />� ,��� _.—_ . <br />If completed license should be mailed somewhere other than the business address, please ad�ise. <br />For o�ce use <br />Receipt # <br />
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