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Massage Therapy Establishment License Application <br />Business Name Bright Touch Therapies, LL <br />Business Address <br />2233 Hamline Avenue North, Suite 125 & 130 <br />Roseville, Minnesotan 55113 -5008 <br />Business Plione <br />Peir-son to Conn ct its Regard to Business License <br />Dame <br />Dianne M. Hansen <br />Address - <br />Mary Wright <br />+ <br />Phone ,� _�_ _. <br />• date of B irtia <br />Drivers License Number <br />Social Security Number <br />U.S. Citizen? Ycs — No Naturalized? <br />(Answered for both Dianne M. Hansen & Diary Wright) <br />If yes, date and place: <br />Yes No <br />hereby apply for the following license(s) for the term of one year, beginning July 1: - - -- - -2003 and ending <br />June 31, 2004 , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Re aired Fee <br />Massage Therapy Establishment S300,00 <br />$1 50.00 Background Cheep <br />(nevi license only) <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation <br />as the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue # 176.182. <br />L <br />Signature <br />Date <br />If completed license should be railed somewhere other than the business address, please advise. <br />For office use Daly: <br />