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FO <br />Tiry <br />V J hE <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 5511 <br />(651) 792 -7034 <br />Massage Therapy Establishment License Application <br />Business Name LT F clu Operot fio-M & . �¢t� , �i�1G• ����G! �t�t"� i fe�r:�i -t���S 5 <br />Business Address <br />Z490 ri14 eyl-oiw <br />Business Phone `491, vn , "44 <br />Email Address <br />Avenues NOYKf V4""Ileoo M N s7ril 3 <br />Person to Contact in Regard to Business License: <br />MAt I*Vt5 ,Legal Name UTT,'- (A446 0 WYI.$ ��(lYV�% 3 �f�i t . Gf p fi SS <br />Address <br />Phone f W1.. - - <br />jL - Drivers License Nu-mcer, <br />I hereby a 1 for the following l icense(s) for the term of one year, beginning July 1, � � } and ending <br />p <br />June 31, - . -- 01 , in the City of Roseville, County of Ramsey, and State of Minnesota. <br />License Required <br />Massage Therapy Establishment <br />Fee <br />$300.00 —" ZL� <br />$150.00 Background Check <br />(new license only) <br />The undersigned applicant makes this application pursuant to all the laves of the state of Minnesota and regulation <br />as the Council of the Liter of Roseville may from. time to time prescribe, including nro ta Statue ##176.182. In <br />addition, the applicant ackno led es that they are responsible for rev' grin the c d an d work h i stor o <br />their emr)1ovees, including those that have received a massave t rar)i �-from t City. <br />t <br />Signature <br />Date <br />If completed license should be mailed somewhere other than the business address, please advise. <br />fD C'OTMr;,te- , Aq <br />tTr, <br />ems- <br />