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2001-04-03 P & Z Agenda
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2001-04-03 P & Z Agenda
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7/17/2009 2:38:16 PM
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7/17/2009 2:36:41 PM
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<br />FOR POUCE DEPARTMENT USE <br /> <br />Date of Application: -1-1_ <br /> <br />CITY OF MINNETONKA <br /> <br />Reviewed <br />Denied <br />Approved <br /> <br />IN SUPPORT OF AN <br />APPLICATION FOR A NEW MASSAGE SERVICE <br /> <br />BUSINESS LICENSE <br /> <br />PART 2 - Personallnfonnation <br /> <br />This application form requests information which may be classified as private or confidential under the Minnesota Data Practices <br />Act. This information is required by State law or City ordinance. The information will be used to determine your eligibility for <br />issuance of a license, permit, or identification card. Failure to provide the information will result in a denial of the license, permit. <br />or identification carel. <br /> <br />Directions: <br /> <br />This form must be filled out with typewriter or by printing in ink by the sole owner, by each <br />partner, by each officer, or director, by each manager, proprietor or other with management <br />responsibilities for the premises, by each person who by combined ownership or control has an <br />interest in a corporation or association in excess of 5%. <br /> <br />True Name: <br />Residence Address: <br /> <br />Maiden Name: <br /> <br />(laIt) <br /> <br />(Fnt) <br /> <br />(FuJI MiddJe NeI.) <br /> <br />Phone: <br /> <br />(Street, City, SllIle, Zip Code) <br /> <br />^ity in which you live: <br />usiness Name: <br /> <br />County in which you live: <br /> <br />(Establiltlment kif which the mlllMQ8 IiceOM is granted or applied for) <br /> <br />Business Address: <br /> <br />Phone: <br /> <br />(SIrHt. City, State, ZiP Code) <br /> <br />Place of Birth: <br /> <br />Date of Birth: <br /> <br />Height: <br />U.S. Citizen Status: <br /> <br />(City, county, State) <br />Weight: <br /> <br />Yes_ No_ <br /> <br />Color of Hair: <br /> <br />(Month, Day, Year) <br />. Color of Eyes: <br /> <br />Social Security Number: <br />Name of Spouse, if applicable: <br /> <br />If naturalized, date and place: <br />Driver's License Number: <br /> <br />1. <br /> <br />Is the applicant licensed in any other community? Yes <br /> <br />No <br /> <br />If yes, where: <br /> <br />2. Has the applicant been denied a massage license by any licensing authority? Yes No <br />If yes, give the name and location of the licensing authority, approximate lime period of the denial, and the <br />reason given for the denial: <br /> <br />3. <br /> <br />Does the applicant have any training or experience in performing massage service? Yes <br /> <br />No <br /> <br />If yes, specify the training or experience: <br />
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