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000� <br />Massage Ther4py �� <br />.- Le Application <br />4•� <br />• r. <br />Business Name <br />Business Address <br />rr <br />Business Phone <br />Person to Contact in Regard to Business se: <br />Name �r� S <br />Address <br />Phone <br />Date 6f BiA Y <br />Drivers License Number <br />Social Secu&Y Number <br />U.S. Citizen? Yes <br />No Naturalized ?: <br />Yes <br />No <br />If yes, date an- d place: <br />I hereby apply for the fOtlOin lip - • <br />June .+. i •ense(s fob`. the rnI.Of Obe, be f�}, ■y■7■�■ and ending <br />-Cduw.& June 31 <br />'n r •, r :.�y�Yr �• •fr+ + +fir�� r <br />CYJ <br />License Required <br />Fie <br />Massage Therapy Establishment <br />150.00 Background Cheek <br />F t <br />The undersigned applicant males this (new- license only) <br />aPpl�.t��u pursuant #� �1 �e <br />as the Council f the i of Roseville laws of the =Mate of Iirnta end r ... <br />Elie rn�.�r fr�rr� time t� <br />time rese ` •r. .� , � . � .� - �a��ri . <br />p nlu �g I"iN ota to W176-182 <br />. <br />Signature <br />- r <br />D4t� <br />If completed license should <br />uld be mailed sOWe *here other than the huslns address, please a dvise. <br />FO,r Oflice use only.- es <br />