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��� �14.. _ <br />City of Roseville <br />Finance Department, License Division <br />2b60 Civic Center Drive, RoseviIIe, MN 55113 <br />{b5I) 792-�7036 <br />Massage Therapy Establishment License Application <br />Business Name � e � �/1 <br />Business Address <br />Busrness Phone <br />Email Acldress <br />� � �- �o�� � L.� <br />� /� � , <br />� �� � ���`-� �h. � -� � ss t <br />Person to Conracr in Re�ard tn F��.���p�� T.rr.en,se: <br />Legal Name <br />Address . <br />Phone _ <br />Drivers �.icense Number <br />_—�_�._-_ � V <br />_ - _. _ . Date of Bir�h <br />I hereby apply for the following Gcense(s) for the term oF one year, beginning July 1, a� , and ending <br />June 3l, ��, 'rn the City of Roseville, County at� RaEnsey, and State of Minnesota. <br />r r.. ., <br />�:rr.:rrri...�.r} - <br />Massage Therapy Establishrrient <br />� <br />$300.00 <br />$l.50.00 Backgroe�nd Check <br />{new Eicense o�ly) <br />The undersigned applicant makes this app[ication pursuant to all tf�e Eaws of the 5tate of Minneso[a and regulation <br />as the Council of the City of RasevilEe may from time to time prescribe, including Minnesota Statue #17b.182. � <br />addition, the applicant acknowEed�es that the,y are responsible for reviewing.Ihe bac[cground anct work histor� <br />their empl_oyees, includin� [hose that have r�ceived a rttassa e�pist. license from the Citv. <br />S�.gnature �� <br />Date t�J � -� <br />Ii compieEed iic�nse should be mailed somewhere other than the business address, please advise. <br />