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l 0 r- <br />City of Roseville <br />Finance Department, License Division <br />660 Civic Center Drive, Roseville, SIN 55113 <br />(651) 792-7034 <br />Massage Therapy Establishment License Application <br />Business Name . <br />1 f <br />Business Address 11Z Le, M rq <br />Business phone <br />Email Address <br />Person to Contact in Regard to Business License: <br />Legal Narue - <br />Address <br />Phone _ <br />Drivers License Nu mbc <br />. I I I <br />I hereby apply for the following license(s) for the terra of one year, beginning July 1, 2..00S , and ending <br />June 31, 2 4D in the City of Roseville, County of Ramsey, and State of Minnesota. <br />License Required <br />Massage Therapy Establishment <br />Fee <br />$300.00 <br />$ 1.50,00 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 applicant acknowledges that they are responsible for reviewing the background and work his f <br />their employees, including <br />_those that have received a massage therapist license from the pity: <br />Signature <br />Date d ! �J' ?.CDC 4F,--) <br />If completed license should he mailed somewhere other than the business address, please advise. <br />