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1� �' <br />1. � J 1 1 <br />City of Rose�ille <br />Finance Department, License Divisio�t <br />2660 Civic Center Drive, Roseville, NIN 55113 <br />(651 } 792-703G <br />Massage Therapy Establishment License Application <br />Business Name L 7 Y! GL �t017 C. �� Q L�� <br />2 d'rrc�i r v i�w �V ��• �� us' I e N SS Ti rMe � i{�t�,S <br />Business Address _ <br />Business �hone <br />Ernail Address � <br />Persora to Contnct irt Regartl to Bttsirtess License: <br />Lega� Name <br />Elddress _ _ _ <br />Phone <br />Drivees License Number <br />- � R . <br />Date of Birth . <br />I hereby apply for the foJlowing license(s) for the term oF one year, beci����ing ,iuly ], '�.GQ , and ending <br />JuRe 3 i, Zb��, �� the City of Roseville, Cot3nry of Ramsey, and State of Minnesoca. <br />I irunCP_�antrirnr� <br />-� �. �.�-.�r�.r-e� <br />Massage Tf�erapy E;tablishment <br />�l�sis <br />�300.00 <br />$15Q.00 �ackground Checi� <br />(new license onl.y) <br />The undersigned applicant mattes this applicatioEl pursuant to all the ]aws of the State of Minnesota and regulatio❑ <br />as the Counci[ of the Ci.ty of Rosev�lle may from time to time prescribe, includin� IViinnesata Statue #176.I82. � <br />addition, the a]icant ack�tawledaes that the are res onsible fo ing the �ack.2xo��id work hist�rv nf <br />Sig <br />Date <br />If compteted license should be mailed some�vhere ather than the business address, pfease ad�ise. <br />