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Jy, <br />City of Roseville <br />Finance Department, License DYVision <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792 -7034 <br />Massage 'Therapy Establishment License Application <br />Business Name JGPenneV Cora inc. #-o4qu-o _ <br />Business Address i�oo w couv�ty �d g -2 Roscville,Mn <br />Business Phone <br />Email Address <br />Person to Contact in Regard to Business License., <br />Legal lame <br />Address - <br />Phone <br />%W Date of B firth <br />L i %. t i f 42 - <br />10, <br />1 hereby apply for the following license(s) for the term of one year, he inninor July 1, 2. 0 0 � , and endiner <br />June 311 2-00 01 in the City of Roseville, County of Ramsey, and State of Minnesota. <br />License Recurred Fee <br />Massage Therapy Establishment 30. <br />$150. ackground 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 history of <br />.heir empl.gype_s including those that have received a massage therapist licepse from the ity, <br />Signature <br />Date <br />MAY 12 2UO8 <br />If completed license should be mailed somewhere other than the business address, please advise. <br />