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SA ON M <br />WAN a on_ 51 <br />City of Roseville <br />Finance Departmen,t, License Division <br />"Ile, MN 55113 <br />2,6601 Civic Ceinter Drive, Ro,sevi <br />(651) 792w7036 <br />Legal Name <br />Address <br />Drivers License Number <br />I hereby apply for the following license(s) for the term of one year, beginning July 1, "U, I I , and ending <br />June 3 1, 2!!VL 1--P , in the Cj*ty of Roseville,, County of Ramsey, and Sitate of Minnesota., <br />Requiced Eae <br />a, <br />Massage Therap stablishment $300.00 <br />$150�.O�O Background Check <br />(new license only) <br />11 A <br />Ile <br />Mt <br />I M*M1 <br />'OF <br />. lib z 0I <br />Signature A <br />Date <br />If completed license should be mailed somewhere other than the business address, please advise, <br />