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Attachment A <br />2. Home Address <br />7. 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 />S. Narne and address of the licensed Massage Therapy Establishment that you expect to be employed by. <br />PO <br />91. Attach a cellified copy of a diploma or certificate of graduation from a school of massage therapy <br />including a rninimum of 16,00 hours in successfully completed course work as described in Roseville <br />Ordinance 1] 6, massage Therapy Establishments, <br />10,. Have you had any previous massage therapist license that was revoked, suspended, or not renewed? <br />yes No If yes explain in detail. <br />License fee is 75,00 <br />Make checks, payable to City of Roseville <br />