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NATIONAL <br />AMUSEMENT <br />COMPANY <br />3924 LOUISIANA CIRCLE. MINNEAPOLIS, MINN. 55426 <br />ELECTRONIC GAMES & KIDDIE RIDES <br />TELEPNONE <br />(612) 925 -3363 <br />A. <br />SAMUEL Q NILVA <br />fl <br />OF LITTLE CANADA <br />Y COUNTY, MINNESOTA <br />kek4 4 dit <br />CLERK OF LITTLE CANADA <br />fr <br />Name % ,77itw't/ AA /Uf Eyr Go <br />LICENSE <br />New X <br />Renewal <br />Transfer <br />License Fee <br />Addressc7Yvl4jLOV /C /.p4/A t'! /,�O.GC <br />City_ST, / / /f/.S' ! State /L1/ �4--" Zip -41-S412.4 Phone 7, X345 <br />hereby apply for a license for the term of One Year in the City of Little Canada, County of Ramsey, State of <br />Minnesota. <br />B. Business Address iJ.4/i XC7— f 2."/Ce- SAD /? CC4 " -2.-Zr <br />City 4 / rrzr (P.A State aor /.4'41 Zip Phone <br />C. Have you been engaged in this business before? Yes <br />2C <br />No <br />D. Where? - 7 'Ptf /,* M /ZS; 1f7"(4 CD /vCrCC'7a6'P F-Mi C,'GL <br />E. If a Firm or Corporation, names and addresses of the officers. <br />Name of Firm $ 4"Y 4//4- VA fit i•(11 77gW4 /4Ards /r Cc' /tip <br />Officers S4 1 /V 1/4 Pins' Address 357/ C Zr%//v/J/"t,r- 4/ <br />114: gib Qf`NCr`' / <br />P.0/10 A11(CC /aA Pas'r' <br />tt.<, M/ AA° TA s -�f� �? <br />Al ///LAN" N rr -rA"</ Src0V15 #4 <br />F. List all licenses currently held (municipal or state) S7 P4 .u4/ A/,CC ; Af Tatx,C'G rrfl C e- <br />6 - t4, //a A .Nr /Av, e red ,Ccfbc/FC a Ed/ -‹ 7' cav; s t"; <br />gr ei s /'Z Aft, 4/ S S v/ <br />Cc i an./ vAt err/ c -r< E,._(C • <br />G. Well Drilling No. Plumbers' Master No. Electricians' State No. Heating <br />Competency No. The undersigned applicant makes this application pursuant to all the laws of <br />the State of Minnesota and such rules and regulations as the City Council of the City of Little Canada may <br />from time to time prescribe. <br />Date <br />C2 _ <br />APPLICANT DO NOT FILL BELOW THIS LINE. <br />Approved for license this date <br />Remarks <br />2gi4 <br />