Laserfiche WebLink
�� <br />*+� r � � � � <br />��--_ . — ^ <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, ����T 55113 <br />(651)792-7032 <br />��a ��� g� T�i �r �p �� ��t��] i ��� �r� ��x � �icense Application <br />� <br />J <br />r <br />E�ti� u i�s�'�°�=� i ie '�'��j'� �1?',.� C'�C� - �. ���.�'�+� t � '��� {. �i.4�''�•'�' �� ��.��� �- ���-'�I ��� � �=� <br />— � �'' . <br />f3 us i nc�s :��d i 44� � �� � ��_��3 f � •�.` �. --- -�:G �•t c'� ��-� - <br />�� <br />� ��� ��� �. � - ��� � . - - _ <br />F3ass int�s Pl7csi7� ��, � � � � � �- �, � .-- � --��- - � -� -- <br />Per-sota to (,'o�rtact in Regard to Bt�si�tess License: <br />�5 ! I �! �y .} �, �s k� � <br />Nai��e � � . �. � 1 . �� � -.� : � ��. <br />� t� <br />.J <br />Address <br />_� _ � _ _ <br />�'hone <br />� <br />Drivers License Number <br />Social Security Number <br />U.S. Citizen? Yes _ �1a <br />L I <br />'� Date of Bii-�h <br />Naturalized? <br />If yes, date and place: <br />� <br />�'t � — — No <br />7 <br />T`— .i � • r <br />I hereby apply for the following license(s} for the term of one year, beginning July I, ��� _, and ending <br />-.: i �ti .-� I.�� :� �� , i�i the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required F��� <br />Massage Therapy Establishment .a ' ' <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 fro�n time to time prescri��, including Minneso �Statue #17C.182_ <br />�� � . <br />r� � {r�- <br />Signature �. ' ��Y���y _ -- <br />� �_ <br />Date � "� �'�' �y - - --• •-- <br />�� 1 <br />If completed license should be mailed somewhere other than the business address, please advise. <br />