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<br />, <br /> <br />CITY O:F LITTLB CAlIIl\DA <br />APPLtCATION FOR MASSAGE THERAPY ESrABLISllMEN'I' LICENSE <br />(Must be accessory or incidental to properly zoned beauty salon.) <br /> <br />Lioense Fee - $100.00 <br /> <br />__ NEW <br /> <br />RENEWAL <br /> <br />Please complete the following. It the application is by a <br />natural person, by such person; it by a corporation, by an <br />officer thereof; if by a partnership, by one ot the partners; it <br />by an unincorporated aeeooiation, by the manager of managing <br />officer thereot. <br /> <br />1. Name of Applicant (name of individual, partnership, <br />corporation, or association): <br /> <br />(If Individual) LAST <br /> <br />FIRS'!' <br /> <br />FULL MIDDLE NAME <br /> <br />2. lfaJ1le ot BClautv Salon under which applicant will be doing <br />business, brtsiness address, and telephone number: <br /> <br />Full Name <br /> <br />Business Address <br /> <br />Srtsines$ Telephone <br /> <br />3. Type oC Applicant: <br />______Individual <br /> <br />_____partnership <br /> <br />_____Corporation <br /> <br />Association <br /> <br />other <br /> <br />4. A. IC applicant is an individual: <br /> <br />Name <br />LAST <br /> <br />FIRST <br /> <br />FULL MIDDLE NAME <br /> <br />Date o1! B1rth <br />Residence Address <br /> <br />Residence Telephone <br />Business Address <br />Business Telephone <br />social Security NUlllber <br /> <br />Driver's License Number <br /> <br />1 <br /> <br />?n .,..; <br /> <br />Q~CbjJQb I CQ_ -nlJ VI-" <br /> <br />l-!1ll-!,lHn ~111 i1 In ,[In <br /> <br />1::>' hI \lml Tn_C::>_lIl-!1J <br />