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<br />t-1;:;:1-27-201l1 10' 03 <br /> <br />612 985 4499 P.04/04 <br /> <br />. <br /> <br />Please read the following swemen~ carefully. By signing below. you agree to and are bound by each <br />iltm. <br /> <br />· lllave MCeived from me City of Lake"ille s copy of the Therapeutic MsssaF Ordil1Allce and will <br />familiarize myself with its provisions. <br /> <br />· J understand that a criminal convlctiOll will not bat me from obtaining a license unless the <br />conviction is <lireclly ~lated to the o<:cupatlon fer which the license is sought and there is no <br />showlllg of sufficient rehabilitation and present fitness to perfom. the dulles of the occupatlOll. 1 <br />understand lbat failu~ to reveal a criminal COnviction is falsiflCatlon of the application and <br />COllsUlU7es ifOunds for denial of the Jjcell~. <br /> <br />· The lnforrnalfon I have provWed on this application is truthful. I authorize the City of Lakeville to <br />investigate the Information and cOlllicl persons/organizations name4 on this application. <br /> <br />Signature of Applicam <br /> <br />Subscribed anc! sworn to before me. a Notary Public, on this _ day of <br /> <br />Notary Public <br /> <br />Attach along With this application: <br />(T1Iese items will nor be returned to rile applicarn! <br /> <br />1, Evidence of the applicant's educational qualifications, including oriiiuals or certified <br />copies of deirees, diplomas and certificate from a certified school when~ this training <br />was received <br /> <br />2 _ A recent photograph <br /> <br />3. Copy of birth e,mitlcate or naturalization !lIlpers <br /> <br />4. Copy of lease fOt bl.lilding to house business (Only If renting) <br /> <br />Return completed application, along w;ttl attaChments, to the City Clerk's 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 />