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Attachment A <br />Massa <br />cense <br />---------------- <br />New License Renewal <br />For License year ending June 30 <br />71. H ie you ever, used or been known by any narne other than the Regal name given in number I above? <br />Yes No If yes, list each nanne along with dates and places where used. <br />10., Have you had any previous sage therapist license that was revoked, suspended, or not renewed?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 />