Laserfiche WebLink
5. Drivers license Numbear .9 - <br />6. Email Aiddresf- <br />T Have you ever used, or been known by any name other than the legal name given in number I above? <br />yes No If'yes, list each name along With, dates and places where used. <br />so <br />0. Have you had any previous m,as,sa,ge therapist license that was revoked, suspended, or not renewed? <br />I <br />Yies No if yes explain in detall. <br />License fee is 1001.00 <br />Make checks payable to City of Roseville <br />