My WebLink
|
Help
|
About
|
Sign Out
Home
2006_0828_Packet
Roseville
>
City Council
>
City Council Meeting Packets
>
2006
>
2006_0828_Packet
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/12/2014 12:57:51 PM
Creation date
8/26/2009 3:38:37 PM
Metadata
Fields
Template:
General
Jump to thumbnail
< previous set
next set >
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
213
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
��� <br />� <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7034 <br />Massage Therapist License <br />New License Renewal <br />For License year ending June 30 ���+�% <br />1_ Legal Name_� � �'� f � � <br />� <br />2. Horne Address . �- Q t A � �,..! <br />- *" +� . � � <br />3. Home Telephone �. : . <br />4. Date of Birth <br />, _ ... � J... . ,... , . , <br />5. Drivers License Number <br />6. Email Address— <br />� <br />7. Have you ever used or been known by any nart�le other than the legal name given in number 1 above? <br />Yes �� No If yes, list each name along with dates and places where used. <br />� � � � � � <br />� �- <br />-, , � , ✓ <br />8. Name and address of the licensed Massa e Th�rnE� F.,��lal iyhinent that you expect to be employed by. <br />��� � a .� � � � �7�-[_� �.�[ 1�. - __�_�__'�a � �, �� t�; SS t �. � <br />9. Attach a certified copy of a diploma or certificate of graduation from a school of massage therapy <br />including a minimum of 600 hours in successfully completed course work as described in Roseville <br />Ordinance 116, massage Therapy Establishments. <br />�p, Have you had any previous massage therapist license that was revoked, suspended, or not renewed? <br />Yes �'' , If yes explain in detail. <br />License fee is 75.00 <br />Mal�e checks payable to City of Roseville <br />
The URL can be used to link to this page
Your browser does not support the video tag.