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<br />~ <br /> <br />1:1. Address (e51) at which you have live<:% during preceding tell <br />years. (Begin with present or last addre51s, and work DacR.) <br /> <br />14. Kind, name, and location of every business or occupation you <br />have been engaged in during the precedinq ten years. (aegin <br />with present business and work back.) <br /> <br />Business or <br />Q,gCUPdtiQn <br /> <br />street Address <br />City ang State <br /> <br />Nature of Business <br />___~r OoCupation <br /> <br />------ <br /> <br />_0_- <br /> <br />'<V"_________. <br /> <br />...~...,--'"", <br /> <br />1~ <br />... <br /> <br />Attach a certified copy of a diploma or certificate of <br />graduation from a schOOl of massage therapy including a <br />minimum of 600 hours in successfully complete~ course work as <br />described in L:l.tt18 canada Ordinance No. 421:>' (Ol'dinance Atcached.) <br /> <br />16. Have vou ever he en convicted ot any felony, crime, or <br />violation of any ordinance other than traffic? <br /> <br />_'.'__ YQS <br /> <br />No <br /> <br />If yes, given in!ormation as to the time, place, and offense <br />tor 1ioIn!ch eonvictiens \~ere had. <br /> <br />--.----,....., <br /> <br />--...----------- <br /> <br />17. Have you been in military service? ._____ Yes _____ No <br />If yes, was discharge(s) ever other than honorable? <br />_.~ ~es No <br />(Upon r~quest, you may be required to exhibit all <br />disoharge" . ) <br /> <br />18. Are you directly or indirectly inte~e$ted in other <br />establiShments in the City of Little Canada to which a <br />license of the sallie kina has been issl.led'? <br />_,,,__ Yes No <br /> <br />o L 'r; <br /> <br />R:::1;t>t>RP [I;~ 'OJI XI:! e <br /> <br />W1\!N\i:i ;;llJ 1} eO ALI:l <br /> <br />Q;;:: ~l ~nlJ rn-Q?-tl8U_ <br />