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<br />t1ffi-27-alI1l1 10: ro <br /> <br />612 985 4499 P.I1I4/11I4 <br /> <br />PleS$e md the following statements carefully. By signing below, you agree to am1 are Oound by each <br />item. <br /> <br />· I have received from the City of LakeviUe a copy of the Therape1.lllc Massage Orc1ll1ance and will <br />familiarize myself with ilS provisiom. <br /> <br />. r l.lllderstand that a criminal conviction will not bar me from obtaining a license unless the <br />conviction is directiy relaled 10 the occupation for which the license is sougbt and rhere is no <br />showlnB of sufficient rellabiUtatlOll and Preselll fillloss to perform the duties of lhe occupatlon. I <br />UlldersWl<1 that failUl'e 10 reveal a cril'flinllt conviction is fa]siflC.lion of the application and <br />cOllStitule$ groWlds for denial of the license. <br /> <br />. The information I have provided on this application is rruthful. I authorUc: the City of LakeviUe to <br />investigate the lnformalion and coulkr persons/organizations nameQ on this Iwlication. <br /> <br />Signature of Applicant <br /> <br />Subsctibed and sworn to before me. a Now'Y Public, on this _ day of <br /> <br />Notary Public <br /> <br />Ana.ch along wIth this application: <br />(These irems will not be returned to rile applicalU) <br /> <br />1. Evidence or rhe applicant's educational qualifications, including originals or certified <br />copies of dearlees, diplotlW and. certificate from a certified school where this training <br />was received <br /> <br />2. A feCCnt photograph <br /> <br />3. Copy of birth certificate or naturalization papers <br /> <br />4. Copy of lease for builcling 10 house business (only if renting) <br /> <br />Return complet"d application, along with attachments, 10 the City ClerJ(1J office at City <br />Hall. 20195 Holyoke Avenue. between the hours of 8:00 a.m. end 4:30 p.m., Monday <br />through Friday, <br /> <br />TOTAL P.04 <br />