Laserfiche WebLink
<br />Ni'l'<-27-213ill 10' e3 <br /> <br />612 SSS 4499 P.il4/il4 <br /> <br />PleMe rlllld tile following .tatements carefully.. By signing below, you agree to aJlli are bound by each <br />item. <br /> <br />· I have received from the City of Lakevillcl a copy of die Therapeutic Massaie Ordinance and wili <br />flIlniliarize myr.elf with il$ proVi3iolU. <br /> <br />· ! understand tha.t a criminal conviction will not bar me from obtaining a license unless the <br />convi<tlOll is directly related Ie the QCcupallon fer wblch the license is sought and mere is no <br />showing of sufficient rehabilitation and present fili\e33 to perform the duties of me =padOIl. I <br />underslan<l that failure to reveal a criminlll conviction i3 !alsific~tlon of the application and <br />constitutes &roUnds (or denial of the license. <br /> <br />. Tbe informadon I have provkltd on this 3ppllcatloll is truthful. I authorize ilie City of LakevUle to <br />investigate the Information and contact persons/organizations Damed on this application. <br /> <br />Siplllre of Applicant <br /> <br />Subscribed and sworn to before me, a Notary Public, on this _ day of <br /> <br />Notary Public <br /> <br />Attach along With this application: <br />mese items will nor /Je returned to ehe applicant) <br /> <br />1, Evidence of the applicant's educational qualifications, inCluding oriiioals Ot certiried <br />copies of deil'ees, diplomas and certificate li:om a certified school whercthis training <br />was received <br /> <br />2. A recent photograph <br /> <br />3. Copy of oirm certificate or narurali2ation papers <br /> <br />4. Copy of lease for hili/ding [0 house business (only if renting) <br /> <br />Return completed application, along wit.1! attachments. 10 ths City Clerk's office at City <br />Hall, 20195 Holyoke Avenue, betwsen the hours of 8:00 8.m. and 4.30 p.m., Monday <br />through FrieJay. <br /> <br />TOTAL P.04 <br />