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WE <br />EMTA E On <br />City of Roseville <br />Finance Department, License Division <br />a 0 <br />2660 Civic Center Dn*ve,:: Roseville, MN 55113 <br />(651) 792-70:36 <br />Massage Therapy Establishment License Application <br />Legal Name <br />Address, Ar dr 40 lip <br />Phone 9 17 - _"F_ -,Date 'alb 'BI*rffi -.7p <br />Din* vers, License Number <br />n1r, / ,and ending <br />C'hiereby apply, Rl.. the, following lic,ensel(s) for the term of one year, beginning July 1, <br />June 3 11 in the City of'Rioseville, Clity of Ramsey', land State of Minnesota. <br />Massage Therapy Establishment <br />r. <br />$300-00 <br />$150i.010 Background Check <br />(new license only) <br />pill <br />On C slol _wj usl <br />A <br />I, <br />If completed license should be mailed somewhere other than the bins , mess address, please advise. <br />