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A" * <br />Ulty OUR10iseville <br />Finance vepartment,, License Divisilon <br />2660 Civic Center Drivie, Roseville, MN 55113 <br />(651) 7921-171034 <br />-V -A <br />2� flog# I <br />Business Name <br />Busini-sis Address 4!! �4 Al <br />Business Phionle, <br />Email -Add riess, <br />Person I Contact in Riegard to Business License: <br />Legal Niame, <br />.4JI <br />Aid dry ess <br />I <br />Phone Date of Birth <br />Drivers License Numbler <br />C�? I /"-I -*-� <br />I hierieby a ly for the following license(s) for the term of one year bleginni Y <br />ng Jul VO �r and eiiding <br />' <br />June, 311, in thile City of Roseville, County of'Ramsiley, and State, off" Minnesota.. <br />License Rtq " <br />m red Flee <br />Massage Therapy Establishment $3,00.0�10 <br />$150.010 Background Check <br />(new licenise only) <br />The undersiglield applicant makes this application pursuant to all the laws of the Stag of'Minniesiota and regulation <br />as the Clounici I of the City of Roseville may from time to time prescribe, including Minnesota Status #1 I61.18 2. In <br />addition the appliciant, acknowledges that ,they are responsible for revi,ewin,,.2 ............ the baickground amp work hi's ter y of <br />their ie,rnp,loyiees, in frip, thiose that have received a mass,ia e them ist license from th <br />9 v <br />Signature <br />Date <br />If completed li"icense should be mailed somewhere other than the bus)"'nesis address,, please advise. <br />.4 <br />