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�. �� I <br />r. <br />� �.,.: <br />, _� <br />;:; ; <br />�- <br />City o€ IiasevilIe <br />Finance Department, Lieense Divisian <br />2G60 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7036 <br />�Viassage Therapy Es�abl�shmen� L�eense Applica�ion <br />nrmnm m�nn� �Aim �mAUm <br />Business Name ��'�'i�`'�5 � t.L,' iM L�,�� a� �. ' <br />Business Address 5�'• �a,�. WL <br />Business Phone , , <br />Email Address , , <br />�-� � <br />Per.son tn Cnrttact in Regard tn Busil:ess Licen.se: <br />Legal Name <br />:� � <br />Address <br />" r <br />Phonc: <br />Drivers License Number <br />DaEe of Birtt� <br />[ hereby apply for the foiiowing license(s) for the term of one year, beginnir�g Ju1y l, �° �` , and ending <br />June 31, ��, in the City of Roseville, County of Rarnsey, and State of Minnesota. <br />� ♦ rL• <br />�i�i�Wiiiii�! �1Ji1�iY <br />Massage'T"herapy Estabiis�►menE <br />� <br />$300.0(7 <br />$150_QEi Background ChecEc <br />{new license only) <br />The undersigned applrcant makes this application pursuant to all the Iaws of the State of Minnesota and regulation <br />as the Council of tEie C�ty of Rosevi�le may from time ta time prescribe, inciuding Minnesota StaEue #176.182. � <br />additinn; the at�plicant acknawledges,that they are responsibie for reviewine the back�round and work history of <br />theix em�lc�yees, inc�udin� those that have.received a massa�e therapis� �icense fror�-i the Citv <br />� � <br />Signatuee <br />Date �, o <br />If completed lirense shvuld be mailed somewhere other than the business address, please advise. <br />�� � P_0. 5 � �'� Q. i �'� `� c1 _ � 5 °l�� � �' lwl 0. L � <br />��`cTN; j��s: c� � <br />q � � (, �. <br />�c� � c ]� <br />F <br />i <br />