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�_�_.. —1-- -�� <br />131 T1TRTr <br />�� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7034 . <br />., <br />Massage Therapy Establishment License Application <br />BusinessName 1 1 � i�iJl �„��,� � ����-+�—� <br />Business ,��Frt�ss t l � � � � � }� � L f� � 1� �% �,,.', � � � �' �% � r � � � � `� <br />��� �� <br />Business Phone <br />0 <br />Erna.i� Address <br />1'erson to Contact in Regard to Business License: <br />���1 r�lar�ra � � � � 4��� �� k � � � �.�� <br />Address _ _ <br />,..�_.�. <br />Phone � � � ,�- Date of Birth <br />Drivers License Number — <br />I hereby apply for the following lzce�ase�s} for the term of one year, beginning July 1, ���, and ending June <br />31, �, in the City of Roseville, County of l�amsey� State of Minnesota. <br />License Reauired Fee <br />Massage Therapy Establishment $300.00 <br />$150.00 Background Check <br />(new license only} <br />ThG �u,dersigaed �P�oe�t 2:r�� f�is ��a!� �►ra� r,� ala � Y�w� ��'ds� ��� $� �t+11�� s��d rr�4arooQr as <br />che C�cc) ui trx Gi� c��evi3� ms�� �am i�r t� ; �,�r;I�e, ���t,�i,�� wii�nt�ca �� y��� ti��. <br />Signature + � L��'�-�'��_.�� ��_-•�� � ''�� <br />Date !n' �V-�� <br />If completed license should be mailed somewhere other than the business address, pie�se advise. <br />����'d �b:E� �@4�–��–� <br />