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�__. <br />Business Name <br />Qusiness 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 />Pers�n to Conlact in Regard to Business License.• <br />Name <br />Address <br />v <br />Phone C�i� V��C�: 5 S'�f`�% <br />1 hereby a ply ior the Pollowin� license(s) for the term of one year, beginning July 1„ �, C'J�inJ Cnding <br />June 30�� �—> in the City of Roseville, County of Ramsey, State of Minnesota. <br />LiCe�tse Required Fee uan#i Tot.il <br />Amusement Device $15.00 � � <br />(()Cf machine) <br />'l'he undersibned 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 prescr�be; i�cluding Minnesota Slatue # 176182. <br />Signature �(%�'y��'-�.ti-� ��."'" � <br />Date ���� <br />If completed license should be mailed somewhere other than the business address, p►c��sc advise. <br />For office use only: <br />>_ <br />�� g x �,e� �� :. � � ,:"� '�� � <br />�? � <br />����4 ��:� � � x i��'Pk q' } v", <br />.�,Qi �� c � �, �"��«la ...'s • <br />