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I <br />Legal Name A 31 12, AM .................. <br />,Address <br />Phone Date of Birth <br />Drivers License Number <br />20`1\ , and endiniiA <br />I hereby apply for the following license(s) for the term of one year, beginning July 1, OP. <br />0 <br />in, the City of Roseville, County of Ramsey', and State of'Minnesot,a. <br />Massiage Therapy Establishment $300.00 <br />$15'0i.O�O Background Check <br />(new license only <br />The undersigned applicant makes, this application pursuant to, all the- laws of the State of Minnesota and regulation <br />aV the Council of t City of Rolsev�ille May from time to time Prescribe, includin Minnesota Statue #176.182. In <br />ackno ltalcvkMund and work h* <br />addition, the ARplicant �s that they are responsible for reviewinp, the, Ist <br />their emplo ees, including, those that have received a, m,as,sa,ge theopis�t license from the but <br />_.I. <br />Signature <br />Date <br />ff'comple�ted license should be mailed somewhere other than the business address, please advise. <br />