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7 <br /> City of Roseville Minnesota <br /> _ Y <br /> Application for Massage Therapist License <br /> `` Please type or print in ink. <br />` /� <br /> ol <br /> h <br /> New License Renewal <br /> For license year ending June 30, <br /> 1. Legal Name 3 &4Sor\ 1i Z <br /> 2. Home Address <br /> 3. Home Telephone <br /> 4. Business Address <br /> 5. Business Telephone <br /> 1 <br /> 6. Date of Birth F <br /> 7. Place of Birth <br /> 8. Are y ou an U.S. citizen? Yes N o <br /> Naturalized? Yes No If yes, give date and place. <br /> (Attach a copy of the naturalization papers.) <br /> 9. Have you ever used or been known by any name other than the legal name given in <br /> number 1 above? Yes No If yes, list each name along with <br /> dates and places where used. <br /> 10. Name and address of the licensed Massage Therapy Establishment that you expect <br /> } to be employed by. <br /> V V� <br /> V <br />