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%� . <br />Ciiy �f Rc�sevil�e <br />F�n�nce Depaxtment, License Divisian <br />2660 Civ�e Center Drive, Rosevil��, �l� 55113 <br />(�51) 79Z-7034 <br />Massage 'Y`herapy Estab�r�hmen� L�cense Applica�ion <br />< ,�}�j{� <br />Business Name � � ' � i V �'... ��, �� � <br />Business Address � " 4�� � lil.�'�U ���ly��Ul� � � � _ <br />Business Phoi�� Ul�� � (_.,� �� � " s''' I �€ �__ _ .� <br />Email Add�ess ' �' � ` '' ; . • � °' ` P � t <br />— � � u __-___ - s �.--- ---- <br />Person to Contacz in Regard to Business License: <br />Legal Nanae <br />Address <br />Phone <br />Drivers r.,icense Nnm��r ^ ' - - <br />� � ��! � J r �! ��-'! `-'t llate of B���th�� _. � . <br />T lzereby appI or the foIlowing lice�tse{s) far tl�e tecm af one year, beginning ,i�ly 1, V'� _, and ending <br />rune 3I, ��, in �he City of Roseviile, County of Racns�y, and State of Minnesota. <br />L icense Re,guired <br />Massage Therapy EstabIis�ament <br />�'ee <br />$300.00 <br />$150.00 Bacicg��ouuc� Chec�e <br />(new license only) <br />The undersigned appiicant makes this a�plication pursu�nt ta al] the ]aws of tiae State ai Minnesnta and reguIatinn <br />as the Council oi tt�� City ofi TZoseville may frart� tirr�e to tzx�e prescribe, ineluding Mi�Znesota Staiue #176.1$2. 1n <br />add'ztia�� the a Iicant acknaw�ed es that �he are res onsible foz� reviewir� �ae bac� zaund and work histor of <br />thei�• e�� la ees i�icludin those rhat have received a massa e€hexa zst license fra�� ihe Cit . <br />Signature ___�' U �� � �%/ <br />Date � � <br />�f cotnpleted license should be mailed snmewhe�•e o�her than the b�asiness address, please advise. <br />