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���5 <br />`��s1�... _ � J� <br />City of Roseville <br />Finance Department, License Division. <br />2660 Civic Center Drive, Rosev��le, MN 55113 <br />(651) 792-7036 <br />Massage Therapy Estabiishment Lic�nse Appl�cation <br />���siness Name <br />Business Add.ress � � <br />Business Phone <br />E�nail Address <br />� <br />� <br />1 �V L. <br />G `Z�"'7 — L 4 � -..j, <br />�'-A . - - <br />Per•son to Contact in Regarcl to Business License: <br />Legal Nan�e ��'��.J � t��lG�_� .._ _ T <br />Address _ ��Ol _ . .�U��%j � �.Q� T l�.k��/ � �. , �ii,���1��l1tLUl�'V ��� <br />Phone ,�_ _ — � Date of Binl. _ <br />Drivers License Nunzbet- : _ � <br />I�ereby apply foG- the followkng license(s) for t.he term of one year, beginning .�uly ];�__,__ �, and ending <br />June 31,�0_! O, in the City af Rosevi.11e, Cotmty of Ramsey, and State of Minnesota. <br />�ir.cu�e� <br />Massage Therapy Estab}ishment <br />�ee <br />$300.p0 <br />� ] SO.OQ Background Check <br />(new license o��ly) <br />The undersigned applicant makes this application pursuant ta all the ]aws of the State of Minnesota and regulation <br />as the C�uncil aF the City of Roseville may from time to Eime prescribe, including IYlinnesota Statue #176.I82. � <br />addition, tE�e applicant acknowled�ges that the, are responsible for reviewin�e background and work history of <br />ih.eir em�lovees, including those that have received a massage thera�ist license from Che Cit�. <br />5ignaTtE � <br />�ate <br />. � � �� � <br />If completed license should be mailed samewhere o�er than the business address, please ad�ise. <br />