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�� � <br />��� <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 />}SuiIF7�££ �81� ! � ��d� �� �1`� � �� �F �'r� �}'f 'j/ _ i�- � � _ ----- <br />I�usla� Addl� _....� 3 � � �f G � � f ��� � SC�} � �. �`�� � <br />�usm�ss Pfr�ree ���� � �E�� — 4�f 9!' .._ -- <br />�. _ . . _ _ _ . <br />Ernai9 ,��dr�sa . � <br />Person to Contact in Regard to Business License: <br />Legal Name <br />Address <br />Phone _ _ � Date of Birth _ <br />Drivers License Number <br />I hereby apply for the following licens�(s) for the term of one year, beginning July 1, ����v r and ending June <br />31, ���� �- in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required Eee <br />Massage Therapy Establishment $300.00 <br />$150.00 Background Checic <br />(new license only) <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation as <br />the Council of the Ciry of Roseville may from time to time prescribe, including Min� ota Statue #17G,182. <br />�� <br />�� 3�r' <br />Signature � `� <br />Date �� � <br />� <br />If completed license should be mailed somewhere other than the business address, please advise. <br />� ��� �� � S � J� ��+�� �S �rr�� �- U�� ����CT� r�� ��f � � f } � �� � . <br />� <br />