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1� <br />.� <br />City of Roseville <br />Finance Department, License Division <br />266p Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7036 <br />I1�assage Therapy Establishment I,icense Application <br />BusinessName C������ �Q� , f j'�G; ��1-�-(��-O <br />Business Adclress � � � a W . � Q l,� � i� (� • � - 2.. � 0 S� Y I � � � }ii � �i -�i 1 I '�j <br />B�siness Phone 1� � � ' � � j - �`�-y� Q <br />Email Address <br />Persarr to Contact in Regard to Business License: <br />Lega[ Name U �i p � �'� � � C Q � . � ii � . <br />Aci�ress . <br />Phone <br />E� . <br />_ r � . vv•� 1 <br />Date of Birth <br />I hereby apply for t6e following license(s) for the term of one year, beginning July 1, � l�`�� , and ending <br />June 31, 2.0 � 0 , in the City of Roseville, County of Ramsey, and State of Minnesota. <br />Massage Therapy Esta6lishment <br />Tee <br />$300.00 <br />$l50.0 ackground Check <br />(new Iicense only) <br />The �ndersigned applicant makes this applicatio�� pursuant to all the iaws of the State of Minnesota and regulation <br />as the Council of the City oFRosevilie may fram time to tim� prescribe, inciuding Minnesota 5tatue #] 76.182. � <br />addiiion the a licant acknowled es chat the are res onsilale for reviewin the back round and work histo of <br />their empl_oyees; 1C1C�U�li1� t}](TSP. [IIAt }tavP rarPiirar-i � ri,.,��.,,.e .�.,._.._�_� ,:_ _ _ _ _ r . �. <br />Signature <br />Date �Y 0 � 2D09 <br />If compleied license should be mailed somewhere other than t.he business address, �lease advise. <br />�,iGPel���eY Co��. inc. <br />Aa �ox �-�o� �t <br />S1� C U.T �d 1-I� I�-} �r - 0 D ci 7 <br />