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Business Name <br />Business Address <br />Business Phone <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 490-2212 <br />Amusement Device License Application <br />����1 t,%___w.T �y� i,t � � 1 �� <br />�l-n�-���^�SG� <br />Person to Conlact in Regard to Business License: <br />Name <br />Address <br />Phone li;,�Ei L��9J'�' <br />I hereby apply for the following license(s) for the term of one year, beginning July 1, , and ending <br />June 30, ,� C: ` in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired Fer uanti Total <br />Amusement Device $15.00 � �o. � <br />(per machine) <br />'l'he undersi�ned applicant makes 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 presgrh�F, including Minnesota Stalue � 176.182. <br />Signature /�c^�'�-�e� G"'�'� <br />Date ; ���j��(71�, <br />If completed license should be mailed somewhere other than the business address, please advise. <br />For of, f ice use only: <br />( '� '4Y' l5 S .��...� <<z.�G � <br />�� �, ��`�����`�:�� � �` � ° <br />�� z���� s , �e� � x - ' , � � '�"��„` <br />