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Massage Therapy Establishment Liacense Application <br />Business Name <br />tu:) - W 7 <br />Business Address � <br />v( �_ -At <br />Business Phone G 5 (0 3q - 05 -1 5� <br />Person to Contact in Regard to Businais License; <br />Name RA Kin,s_ <br />ddress <br />r <br />ome ,2 — (o (o !i Date of Birth <br />Drivers License Ntuuber <br />S ocial 8 eeuuity Number <br />U.S_ ci&en des ._W. - No Naturalized? _ - - -Yes -- - No <br />If yes, date and place <br />I hereby apply for tkLe following license(s) for the tern of ane gear, be inning July 1, land ending <br />June 31, _ + in the City of Roseville, County of Ramsey, State of U&mesom <br />License Regttired Fee <br />Massage a Therapy Establisbment <br />$150.00 Background Lek <br />(new license only) <br />The undersigned applica m*es this application pursuant to aU the laws of the Mate of Minnesota aud regulation <br />as the Ceumcil of tbLe City of Roseville may from time to time prescribe, ' Ouding Mbxesota Statue ## 176.182. <br />Slgaature <br />t - <br />Date 3 <br />If completed license should be mailed somewhere other than the business address, please advise. <br />/ <br />lj�i� / //� <br />/ /i <br />// � <br />'9,'fyr�rr ��Oa�Vl fG�lY��a�/ iJ% i�����/ iJrlv�� /�j %✓a��Y °�I�,`i� °6y'f��% irk <br />i <br />