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I \ JIB %�IIII i <br />City, of RoseviH,e <br />Fienance Department, Lii,cien,se Division <br />26601 Civic Center Dn"ve, Roseville,, MN 55113 <br />( 1 <br />719�2-i7O36 <br />Massage Therapy Establishment License Application <br />?e OL (OV <br />Business Name <br />Diri r�s License Number <br />I hereby apply for the following hicense(s) for the, tenn ofone year, beginning July 1, !!!A011 and ending <br />June 31 1, in the, City of Roseville, County of Ramsey, and State of'Minne,sot,a. <br />Massage, Therapy Establishment <br />$30�O.,00 <br />5450.00 Background Check <br />(new license onIA <br />or P <br />I A 11 <br />im Sim Amm's 11 Be VZO EM 5% ME, <br />. MMIMI <br />Signature <br />Date <br />If completed license should be mailed somewhere other than the business address,, Please advise., <br />