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2008_0128_packet
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2008_0128_packet
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12/28/2011 4:33:23 PM
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12/28/2011 3:54:10 PM
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d--j i <br />uty of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7034 <br />19" <br />Massage Therapy Establishment License Application <br />. . .......... <br />Business Name -AA-f�-5-SAA, � h., <br />Business Address f- T 11 W <br />Businegs Phone <br />Bel Address <br />Person to Contact in Regard to Business License: <br />LegaiName --,- h <br />Address <br />Phone <br />Drivers Li, ease Number <br />ROSOMI�P qA) 65U3 �5 5 <br />I hereby apply for the following ficense(s) for the term of one year, beginning July 1, and Onding <br />june3j, in the City of Roseville, County of Ramsey, and State of Minnesota. <br />License, &o Ux" red <br />Massage Thorapy Establishment <br />Fee <br />$300.00 <br />$150.00 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 />as the Council of the City of Roseville may from time to time prescribe, 'Including Minnesota Statue #176.182. In <br />addition the ap-plicant acknowl s that the mresponSible for reviewin the back round and work history o <br />their ei-nploy ens ,includiny, those that have received a massage- then Est license from thg City, <br />61, <br />Signature-K-X� . . .... ........... . ......... . ... . ......... . ............ . ... . <br />Date 7 <br />ff completed 11" tense should be mailed somewhere other than thie basiness address, please advise., <br />
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