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W WIP, S J. <br />V k V <br />ks, <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MIS 55113 <br />(651) 792 -7036 <br />Massage Therapy Establishment License Application <br />ron r r- <br />Business Name <br />Business Address _ .� 3 C. � - r a roe ego _f _ <br />Business Phone '7 � Y <br />Email Address 4eVAt " <br />Person to Contact in Regard to Business License: <br />Legal Name <br />Address <br />-J - <br />Phone -- -- Date of Birth <br />Drivers License Number <br />I hereby apply for the following l.i ense s for the term of one year, beginning July 1., , and ending <br />June 3 1, .. , in the City of Roseville, County of Ramsey, and State of Minnesota. <br />f <br />Massage Therapy Establishment <br />L4 ee <br />$300.00 <br />1.50.00 Background Check <br />(nevi license only) <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation <br />as the C uncII of the City Roseville may from time t time prescribe, including Minnesota Statue #176.182. La <br />addition, the applicant acl n rl es that the are responsible for reviewing the .ek round and work Kist <br />their employees, including, those that have received a massage therapist fi ease from the City <br />Signature <br />Date <br />If completed license should be mailed somewhere other than the business address, please advise. <br />