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CITY OF ROSEVILLE <br /> FINANCE DEPT, LICENSE DIVISION <br /> 2660 CMC CENTER DR, ROSEVILLE, MN 55113 <br /> (651) 490-2212 <br /> MASSAGE THERAPIST LICENSE APPLICATION <br /> APPLICANT'S NAME: <br /> � (MIDDLE) <br /> DATE OF BIRTH: <br /> RESIDENCE ADDRESS: I <br /> RESIDENCE TELEPHONE: <br /> BUSINESS ADDRESS: ,�`�"S `� �i i�� �f, IV 1(��s�a�r��p; �l1'I S 5117 <br /> BUSINESS TELEPHONE: <br /> NAME & ADDRESS OF THE LICENSED MASSAGE THERAPY ESTABLISHMENT THAT YOU <br /> EXPECT TO BE EMPLOYED BY: <br /> 4 5�9 .. R)e'r (I- <br /> I hereby apply for the following license for the term of one year, beginning July 1,2002, and ending June <br /> 30,2003, in the City of Roseville, County of Ramsey, State of Minnesota.. <br /> LICENSE REQUIRED: FEE <br /> MASSAGE THERAPIST $75.00 <br /> The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and <br /> regulations as the Council of the City of Roseville may from time to time prescribe, including Minnesota. <br /> Statue #176. 182. <br /> Signature <br /> µ� <br /> Date Q G <br /> **If completed license should be mailed somewhere other than the applicant's residence address, <br /> please advise. <br /> Receipt # <br />