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IMMJ WITA 8 59 <br />UL <br />City of Roseville <br />Finance vepartment, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7036 <br />i ion <br />Massage Therapy Establishment License Appflcat <br />Business, Name Af L,L L <br />Business Address it, <br />qr <br />Business Phone, <br />Email Address a of c� <br />Person to Contact in R'e to Business License: <br />Legal Name <br />A A A 0 <br />Address <br />"A. <br />Phone Date of Birth <br />I hereby apply for the following ficense(s) for the term, of one year, beginning July, 1, ;L 6 t ( , and ending <br />June l', ;,OIX , in the City, of Roseville, County of Ramsey, and State of Minnesota. <br />Massage Therapy Establishment <br />$3100-00 <br />$,1501.00 Background Check <br />(new license only) <br />The undersigned applicant makes this applicafion. pursuant to all the laws of the State of Minnesota and regulation <br />as the Counclit, of the City of'Roseville may from time, to time, prescribe, includin Ml*nnesota Statue #176.182. la <br />addition,, avvlicant a&nowledges, that they are resip, nsibil,e for reviewing e gackpround and work history of <br />their emplovees, includffig Those that have received a'massagle rapist , license from the <br />Signature, <br />Date 6121111 <br />If' completed license should be mailed somewhere othier, than the business address, please advise. <br />