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���� � <br />��M�� 1 , 1 � � <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7034 <br />Massage Therapy Establishment License Application <br />� <br />' �r� F � k � �Y�G'�i/ ��i.•• 1�'a <br />Business Name ��� ��� G,. � � ���{ � �� t. 4 w 6�� � _ �r.�c�' ��-� ���. <br />� - - – <br />Business Address ����� `�+���-�- � �� � � �� � "+�� �� <br />Business Phone �� � ti � r� � � �� <br />Err�ail Address - � , �� � � '.,�• 'k;- � . � - <br />Person to Contact in Regard to Business License: <br />�r . r " <br />Legal Name _„'"'�' ,.� �,.a`�� . r _ <br />Address - � • <br />Phone <br />J�ri�rers Li�en�c T*Ivm� : • - • - <br />� �� , _ <br />.—_ —Date of Birth— <br />I hereby apply for the following iice��sa{s) for the term of one year, beginning July 1, � c�} �, and ending <br />June 31, _� f�� r in the City of Roseville, County of Ramse��2�c� State of Minnesota. <br />License Reauired <br />Massage Therapy Establishment <br />Eee <br />$300.00 <br />$150.00 Background Check <br />(new license only) <br />The undersigned applicant makes this application pursuant to all the laws of Ll;� State of Minnesota and regulation <br />as the Council of tlle �"ity of Roseville may from time to time prescribe, including Minnesota Statue �]'��.1 �� fr� <br />addition. the apvlicant acknowled�es �lxatthev are responsib�e for reviewin� the back�round and work histor�of <br />their emplovees. includin� those that lzave received anassa�e therapist license from the Citv. <br />� <br />Signature ��� � <br />�ate 5- 22 — O 7 <br />If completed license should he mailed somewhere other than the business address, please advise. <br />