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�. ��� � <br />�r1.= � . .�. �! � <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55123 <br />(651) 792-7034 <br />Massage Therapy Establishment License Application <br />Li�i SGr�eS{ �� i7;c <br />Business Address <br />Business Phone <br />E�nail Address <br />�- . . .. . , � � { <br />,f 5�� •/� ,� �, � 5l , Y,�-�, -;-- <br />���4 _L�'�r�l.� �s.�,l . 1� ���F { � <br />��--- '; i � <br />. ��� ��? SY�: �. �rr,.��'C,�i,� . ' Q =�� I� <br />�,� �� J �r— �—�:�� <br />—S--r��-� 4 ��' � �• �. : Y.Y � ?� <br />Person to Cantact in Regard to Business License: <br />a- <br />Legal Name ��.,��-����'��l � ; <br />Address <br />Phone <br />Drivers License Number <br />� <br />l�at� of Birth- <br />� hereby apply for the following iicense(s} for the term of one year, beginning July �,���_, and ending <br />June 3�,�, � the City of Roseville, County of Ramsey�nd State of Minnesota. <br />License Reqvi.r..ed <br />Massage Therapy Establishment <br />r� <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 the State of Minnesota and regulation <br />as the Council of the City of Roseville may from time to ti�r�e prescribe, including Minnesota Statue #176.I82Tz� <br />addition. the a�licant acknowled�es thatthev are rest�onsible far reviewin� the back�round and wark l�istorv of <br />their enl�lovees, includin� those that have received anassa _ e therapist license from the Citv. <br />�_. - l. `�I <br />Signature � `,�� �i �11��,-f +��� ��� <br />Date r��r� ��� <br />. � <br />If completed license should be mailed somewhere other than the business address, please advise. <br />