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��� � <br />��� �� � <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55ll3 <br />(651)792-7034 <br />Massage Therapy Establishment License Application <br />«���� �:��;� ��� �_� ��,_ ���� ' �� , <br />�- -- -- �+�-��. __ . �_— �- <br />�USIlMfSS }��C�bS ..��,�• � ���AFf_��� ��'- � •���� � ��_ <br />Btisir.eaa Phone �� ��- �I �� ��� � � � �` — — <br />�� ,r . r. .� <br />EMaiE �4d���� ._, _.._ .. -- <br />__. �. <br />PeYSOn to Contact in Regard to Business License.� <br />1.tP�l trlarn� ����,(�� �1��.�y, �� ��—�� _ . -- — <br />A iidrC�- � l �� �������������� i'�_� � ���� �� _._ � <br />Phone �-� Date of Birth <br />. --ti <br />Drivers License Number <br />I hereby apply for the following Eic�nse(s) for the term of one year, beginning July 1, �,� �, and ending June <br />ti 1_�,�?'� , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required �'ee <br />Massage Therapy Establishment $300.00 <br />$150.00 Bacicground Checic <br />(new license only) <br />The undersigned applicant malces this a�plieation pursuant to all the laws of the State of Minnesota and regulation as <br />the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue #176. t$2. � <br />�t��'- . <br />Signature ��_� � � ,_ _� _ <br />r � '�f�p <br />J �J�L' _ _'�� �`- _ - " '. ._. <br />If completed license should he mailed somewhere other than the business address, please advise. <br />