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NO& IRA a <br />it of-Roseville <br />@I <br />Finance Department, License Division <br />2,660 Civic Center Drive, RoseviRe, MN'5511,3 <br />(6151) 792-71036 <br />Ma,s,sia,ge Theraply, Establishment License Application <br />— - - - - - --------------------------------------------------------------------------------------------- <br />i k-It, <br />0 <br />4V <br />OW <br />E,m,ail, Address <br />Person to Contact in Regard' to Bustness License: <br />P%. A <br />Ugal Nme 6 xF LA - 9.W?v W X W — &V a Lf A, <br />91 '%Lit <br />Address .-z Im L-e <br />Phone Date of B irth---------JL <br />Drivers License Number . . .. . .... ..... <br />1 hereby appily for the following license(s) for the term of one year, beginning July 1, and ending <br />I <br />June, 3 1, U! )L in ffie City of Roseville, County of Ramsey, a,n,d State of Minnesota. <br />Massage Therapy Establishment <br />In M-L� <br />$300,.,00 <br />$150.00 Background C,h,eick <br />(new license only) <br />I <br />The undersigned applicant makes this application pursuant to all the laws of the State olf'Minnesota and regulation <br />vi <br />as the Council of the City, of Roseville may from time to time prescribe, includin , Minnesota Statue #176.182. In <br />addition., the applicant acknowledRes, that ihev are resRonsible for reivi,ewi,ng the 9ackjaround, and work history of <br />their eMRloyees, including those that have,, received a massguge theiravist license friolm th <br />- A <br />Signature <br />Date <br />0 <br />I'f compl,eted license should be mailed somewhere oithe,r than the busliness address, please advise. <br />