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2002-03-12 P& Z Agenda
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2002-03-12 P& Z Agenda
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7/20/2009 9:29:29 AM
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7/20/2009 9:26:06 AM
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<br />FOR POUCE OEPARTMENT 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 />APPLlCA TJON 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 card. <br /> <br />Directions: <br /> <br />This form must be filled out with typewriter or by printing in ink by the sole owner, by ~ <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 /> <br />Maiden Name: <br /> <br />(.....1) <br /> <br />(First) <br /> <br />(FuU Middlll N8mlll) <br /> <br />Residence Address: <br /> <br />Phone: <br /> <br />(Street, City, Stat_, Zip Code) <br /> <br />City in which you live: <br />Business Name: <br /> <br />County in which you live: <br /> <br />{Ettaalilhm.rn torwnictl the m.... Nc:enM iI grartHtd O(."plidd fOrJ <br /> <br />Business Address: <br /> <br />Phone: <br /> <br />(Street. City, Slale, Zip Code) <br /> <br />Place of Birth: <br /> <br />Date of Birth: <br /> <br />(City, County,SllIte) <br />Weight: <br /> <br />No_ <br /> <br />Color of Hair: <br />If naturalized, date and place: <br />Driver's License Number: <br /> <br />(Month. 08y, Vear) <br />Color of Eyes: <br /> <br />Height: <br />U.S. Citizen Status: Yes <br />Social Security Number: <br />Name of Spouse, if applicable: <br /> <br />1. <br /> <br />Is the applicant licensed in any other community? Yes <br /> <br />No _ 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 time 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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