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�,� ��,i � <br />��� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Rc�seville, MN 55ll3 <br />(651) 792-7034 <br />Massage Therapy Establishment License Application <br />� <br />BusinessName • f �i �L' ;3 � �.1 i ��d "`� ��� r`�,�*�2 fr s'1 � �1 � �� 't 4 �� Y r��: <br />� I <br />L�us�r�c9s Ad�fa�s� t ��� � �.s�G��''. + � � __.. .�,ti $�a d �f'� ���J�r �:� a � � �.�� � �...— <br />Business Phone '� � � - � -� I ° ���,� ��-� <br />�z�aail Address <br />Person to Contact in Regard to Business License: <br />C�t�;i] f5�nn�� ���.�4�. I� � `fi �:}� L� '�- -- • -- <br />{�y •'S �� I � <br />J"L�1 C�i� • _ b_-ia Y� i- _ LC____ __._ _ . <br />i <br />, n + <br />Phone <br />Drivers License Number � � � � <br />Date o f Birth <br />I hereby apply for the following Iicense(s} for the te� of one year, beginning Ju1y 1, ��' �, ,,, and ending June <br />31, .�,� [J i� _, in the City of Roseville, County of Ramssy, State of Minnesota. <br />License Required ��� <br />Massage Therapy Establishment - �3�411.� <br />�l.$i� O��Bsck�-oanu� Check <br />'.(i�e4v lscense only) <br />The undersigned applicant makes this application pursuant to all the laws o f the State of Niinn�sot� and regulation as <br />the Council of the City of Roseville may %a�. time to lime prescribe, including ���aw�� Statue �175.182. <br />.}! � rl <br />t <br />.4't]�H�i17iC � � � _ . .. _ <br />�k�RI��L45t4F#t' <br />�a,� �'� �Y � � ��� — - — <br />If completed lice�se should be mailed �t�mevv�ae�e other than the business address, please advise. <br />