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2003_0915_packet
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2003_0915_packet
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10/20/2011 4:47:27 PM
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10/20/2011 4:15:27 PM
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r - Vilif Vii <br />massage Therapy Establis ent License Application <br />B�;o�fix,o,� iY1rYlE Enterprises LAC GLba k'a.ou-cs <br />l0 Wo <br />8 5 Qi onne S+ rKou t <br />Business Address rylrP S � <br />Roseu 1% 1 le Mn 55113 <br />Business Phone <br />Person to Contact in Regard to Busfness Lieeitr¢: <br />Name 1�1 � Ch v CUe_X S <br />Addre !is <br />darn P - <br />Phane - . F T ..� Date of birth <br />Y <br />D riv= License Dumber .� <br />T.T.S. citizen? - - -Yes No 14aftWi d? Yes No <br />If fires, date and place: <br />1 hereby fot!0 followi licenses for the tern of one year, be inn Jul 1, . 0 � } and en&9 <br />June 311 0 in the City of Roseville, County of fey, State of Minnesoar.. <br />License Required <br />�e <br />Massage Therapy Establishment $300.00- . <br />150.00 Background Check <br />(new license only) <br />Tte undersigned applicant rakes this application pursuant t0 all tie laws of the State of Nfmnesota and replation <br />as the Council of the Ciry of Roseville may f= time to time prescribe, including Minnesota Statue #176.182. <br />igutue <br />Date cf� 0 :3 <br />If completed Heense should be nailed somewhere other than the business addrew, please advise. <br />TOTAL P.01 <br />
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