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f -1 - <br />41 *4U WAWA <br />C a A Ville <br />ity of"Rose <br />Finance Department, Liecense Division <br />2660 Civic Center Drive, Roseville, MN 5511 <br />(651) 792-7036 1 <br />Perso�n to Contact in Regard'to Business Lice�nsee: <br />Legal, Name,_ <br />t 4 epx 011, <br />Mone Date ofBirth—___1 <br />Drivers License Number I k-111 f <br />The, undersigned applicant makes, this application, pursuant to all the laws, of the State of Minnesota and regulation <br />4 <br />ci ng in <br />as the Coun *1 of the Clity of Roseville may from time to time prescribe,, I'ncludi nesota Statue #176.182. LR <br />addition, t h e gRplicant a&nqw led ges that they are resl2onsible for, reviewing the, back around and work histojy <br />their .lern ployees, including those that have received a massage therap 11 st license from the <br />Signature <br />Date 6P, L,;)- Il ( <br />If'completed license should be ma,i,lied, somewhere other than the business address, please advise. <br />