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<br />Date of Application: _'--f_ <br />Business License Fee: <br /> <br />'tJ' <br /> <br />-)'f: .; ,,~, <br />J <br /> <br />FOR POLICE DEPARTMENT USE <br /> <br />s' <br /> <br />Reviewed <br />Denied <br />Approved <br /> <br />CITY OF MINNETONKA <br /> <br />APPLICATION FOR A NEW MASSAGE SERVICE <br />BUSINESS LICENSE <br /> <br />PART 1 - General Information <br /> <br />This application form requests information which may be classified as private or confidential under the Minnesota Data <br />Practices Act. This information is required by State law or City ordinance. The infonnation will be used to detennine your <br />eligibility for issuance of a license, pennit, or identification card. Failure to provide the information will result in a denial of <br />the license, permit, or identification card. <br /> <br />Directions: <br /> <br />This form must be filled out with typewriter or by printing in ink. If the application is by a natural <br />person, by such person; if by a corporation, by an officer thereof; if by a partnership, by one of the <br />partners; if by an unincorporated association, by the manager or managing officer thereof. <br /> <br />1. Name of applicant (name of individual, partnership, corporation or association): <br /> <br />2. Business Name: <br /> <br />Business Address: <br /> <br />Phone: <br /> <br />(SlrHt, City, Slate, Zip eoa-) <br /> <br />IF BUSINESS IS TO BE CONDUCTED UNDER A DESIGNATION. NAME OR STYLE OTHER THAN FULL INDIVIDUAL NAME OF THE <br />APPLICANT, ATTACH A COPY OF THE TRADE NAME CERTIFICATE, AS REQUIRED BY CHAPTER 333, MINNESOTA STATUTES, CERTIFIED <br />BY THE CLERK OF THE DISTRICT COURT. <br /> <br />3. <br /> <br />Type of applicant: <br /> <br />Natural Person (individual) <br /> <br />Partnership <br /> <br />COrporation <br /> <br />Association or other <br /> <br />Individual <br /> <br />4. The full name, residence address and telephone number of the manager, proprietor or other agent in charge of the premises to <br />be licensed. <br /> <br />Name: <br /> <br />Address: <br /> <br />Phone: <br /> <br />(Street. CJty, Slat.. ZIp Code) <br /> <br />Business Premises: <br /> <br />Property Owner: <br />Owne(s Address: <br /> <br />(Street, CIty, Stale, Zip Code) <br /> <br />Owne(s Phone: <br /> <br />(AnI_ Code .,d Number) <br /> <br />Attach copy of lease, mortgage, or property tilIe. <br />5. Is the applicant licensed in any other community, and if so, where: <br /> <br />Has the applicant previously been denied a massage license by any licensing authority? Yes No <br /> <br />If yes, give the name and location of the licensing authority, approximate time period of the denial, and the reason given for the <br />denial. <br />