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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 />-- ___ .___ _ _� ._.... ....... . <br />,---- --- __ --- — _ <br />Business Name <br />Business Address <br />�i�/�r l% � ��'.�-' <br />Business Phone ���i ,% ° � �'�'�' �� �`� ....�i �7� <br />Person to Contact in Regard to Business License: <br />Name <br />Address <br />Phone <br />a° ,:--- , <br />�~��,-'�..I -" �� �' --�, , c� :,�,,�;-,.��" <br />I hereby apply for the following license(s) for the term of one year, beginning 7uly 1, 2002, and ending 7une 30, <br />2003, in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required <br />Amusement Device <br />Fee <br />$15.00 <br />(per machine) <br />uantit Total <br />- ��� - ._� � <br />The undersigned 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 prescribe, including Nlinnesota Statue # 176182. <br />M � r� . <br />Signature %'�,.'�=�'''�� %t"�:�� /..-,��,, ':�`.'���'.��,�:�_,�..--:'Y-.�i"� <br />�..� � � ., _ .� <br />_� <br />Date ,rt%`� _� , , ?<�' r" =.i <br />_ ;� a - --- - <br />If completed license should be mailed somewhere other than the business address, please advise. <br />For offrce use only: <br />