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<br />".-- <br /> <br />r'I~-27-2el~l 10: 03 <br /> <br />~12 985 4499 P.04/04 <br /> <br />Please rlllld the following stalements c~f"IJy _ By signing below, you agree to and are bound by each <br />item. <br /> <br />· 1 have received from the City of Lakeville a copy of the Therapeutic Massage Ordinance and wili <br />t'.4llliliarize lnyself with its provi~iolU. <br /> <br />. I understand that a cri1ninal convk:tion will 11O[ bar me from obtaining a license unless the <br />cGnviclion is directly related to tile occupation for which the license is sought aDd tIlere is no <br />showing of sut't\clent rellabllllatlon and pre,elll tillle$S to perform the duties of the oc:cupadon. I <br />underSWld that fallure to reveal a crlll1ilul! eonvictiOllls tillsiflCatlon of the application and <br />constilUtes grounds for denial of the license, <br /> <br />. The informatlon I have provided on this application is truthful. I authorize the City of Lakeville to <br />investigate the information and conillcl peroonslOl'llan.i.l:ations named On this application. <br /> <br />SiiDature of Applicant <br /> <br />Subscribed and sworn to before me. a Notary PIIblic, on this _ day of <br /> <br />Notary Public <br /> <br />Attach along With this application: <br />(TI1ese items will not be returned to the applicant) <br /> <br />1, Evidence of the applicanr's educational qualifications, inclUding oriiinals Qf certified <br />copie, of deifees, l2iplornas and certificate from a certified school where this training <br />was received <br /> <br />2. A recent photograph <br /> <br />3 - Copy of oirth certificate or naruraJi2ation papers <br /> <br />4. Copy of lease for building (0 house busmess (Only jf renting) <br /> <br />Return completed application, along witll attachments. to the City Clerk'lj office at City <br />Hall, 20195 Holyoke Avenue. betlAieen the hours or 8:00 a-m. end 4:30 p.m., Monday <br />through Frias y. <br /> <br />TOTAL P.84 <br />