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d�'� <br />�� <br />City of Roseville <br />Finance Department, X,icense llivision <br />2660 Civic Center Drive, I�oseviIle, MN 55113 <br />{dsx����-�a�s <br />Massage Th�rapy Establishment License Appi�cation <br />Business Name <br />Business Address <br />Business Phone <br />Email AdcEress <br />� <br />�� <br />-�- ... <br />. , _ .._ <br />Persa� to Cnnract in Regard ta Business Licen,se: <br />Legal Name <br />Address <br />Yhane <br />u <br />� <br />Q � 4 J GL� <br />- . . i _ _ o . , y - - , <br />- � <br />�_. - <br />-- --� Date of �irt <br />Drivers License Nwnbei <br />i hereby ap�ly for the following license(s) for the term of one year, beginning July l, , ancl ending <br />June 3I, , in the Ciry of Rosevi[le, County of Ramsey, and State of Minnesota. <br />�eus�&�}�Gi.�c�l <br />Massage Therapy Establishment <br />� <br />$300.00 <br />$ ] 50.00 Background Check <br />(new Iicense only) <br />The undersigned appEicant makes this applicatian pursuant to all the ]aws of the State of Minnesota and regufation <br />as the Counci[ of the City af Roseville may from time to time prescribe, inc�udin� M.innesota Statue #17b.1 g2, � <br />addition. the annlic.anr arknnwlP�i�P� rh�t rF,o., .,�o .-�,.�..._..:Li_ r__ _ • . <br />iheir em lo ees incladin those t�at have receiv�d a massa e thera ist license froEn the Ci`t L <br />� , <br />Signature �� t r ,�(,�'j <br />bate � — Q � — <br />if completed license shouid be mailed somewhere other than the business address, please advise. <br />